
gass tvin 

Book .O(o 



2- 

THREE 

DISSERTATIONS 

ON 

BOYLSTON PRIZE QUESTIONS 

FOR 

THE YEARS 1806 AND i807. 

— *• — V 
BY GEORGE CHEYtfE SHATTUCK, M.D. 



THE DISSERTATIONS TO WHICH THE BOYLSTON PRIZE MEDALS 
WERE ADJUDGED. 

TO WHICH IS PREFIXED 

THE PUBLIC ACCOUNTOF THEIR ADJUDICATION, 



1. 

TRAHIMUR OMNES STUDIO LAUDIS. 

Cicero pro Poeta Archia. 






TEMPERAMENTORUM INSTRUMENTUM EST CUTIS. 

Riverius. 

ME PINGUEM & NITIDUM, BENE CURATA CUTE, VISES. 

Hor. Epist. 1. lib. 4. /. 15, 
3. 

VXSTRiE PETXTIONI RESPONDEO DILIGENTER. 

Roger Bacon. 



j OF COftJG*^ 

V, 1 



PUBLISHED BY FARRAND, MALLORY, & CO. AND HASTING 

ETHERIDGE, & BLISS, BOSTON ; BY HOPKINS & BAYARD, 

NEW-YORK ; AND HOPKINS & EARLE, PHILADELPHIA. 



Belcher and Armstrong, Printers. 
1808. 



<f.\« 



!;" 



DISTRICT OF MASSACHUSETTS, TO WIT : 

BE IT REMEMBERED, That on the seventh day of October, in the 
thirty-third year of the Independence of the United States of America, 
Farrand, Mallory, & Company, of the said district, have deposited 
in this Office the title of a Book, the Right whereof they claim as Pro- 
prietors, in the words following-, to wit :■ — " Three Dissertations on Boyls- 
ton Prize Questions for the years 1806 & 1807. By George Cheyne 
Shattuck, M* D. Being' the dissertations to which the Boylston prize 
medals were adjudged. To which is prefixed the public account of their 
-adjudication. 

1 -Trahimur omnes studio laudis — Cicero pro Poeta Archia. 

2 — Temperamentorum instrumentum est cutis. Riverius. 
Me pinguem & nitidum, bene curata cute vises. 

Hor. Epist. 1. Lib. 4. L. 15. 
3 — Vestrx petitioni respondeo diligenter. Roger Bacon. 
In conformity to the act of Congress of the United States, entitled " An 
Act for the encouragement of Learning, by securing the copies of Maps, 
Charts, and Books, to the authors and proprietors of such copies, during 1 
the times therein mentioned ;" and also to an act entitled, " An act sup- 
plementary to an act, intitled, An act for the encouragement of Learning, 
by securing the copies of Maps, Charts, and Books, to the authors and 
Proprietors of such copies during the times therein mentioned ; and ex- 
tending the benefits thereof to the Arts of Designing, Engraving, and 
Etching Historical and other Prints. 

WILLIAM S. SHAW, 
Clerk of the District of Massachusetts 



TO 

Ward Nicholas Boylston, Esq. 

THE FOUNDER OF THE INSTITUTION FOR THE ANNUAL DISTRI- 
BUTION OF PRIZE MEDALS TO THE AUTHORS OF APPROVED 
DISSERTATIONS UPON IMPORTANT MEDICAL SUBJECTS 
COMMUNICATED FOR DISCUSSION. 



Dear Sir, 

I experience a peculiar pleasure in 
inscribing to you the following sheets. From you, 
as the author of that Institution, whose committee 
have set in judgment upon them, they originated in 
the germ, and, to you, as now unfolded, they are most 
naturally dedicated. This pleasure would be much 
increased, if they were more worthy of inscription 
to the man, who has been so eminently distinguished 
in the exercise of that god-like virtue, benevolence. 
The disciple of eloquence and the student at medi- 
cine alike hail you as their patron* and benefactor. 

That your benevolent wishes to subserve the 
good of the republic by rendering our young men 

* Harvard University is indebted to Mr. Boylston, not only for its Pro* 
fessorship of Rhetoric and Oratory (the chair of which is filled by the Hon, 
John Quincy Adams), but forks Anatomical Collection and Medical Library, 



IV DEDICATION. 

eloquent, and to diminish the sum of physical suf- 
fering by your attempt to promote discovery in the 
divine art of healing, may all be realized, is the 
fervent prayer of every friend to man, but, be 
assured, Sir, of no one more sincerely, than of 

Your obliged and 

very humble servant, 

GEORGE CHEYNE SHATTUCK. 

2To. 13, Middle Street^ 
October 3d, 1808. 5 



PREFACE. 



A physician, in submitting his labours to 
public examination, should feel the same unconcern 
for the consequence to his reputation, as the chemist 
feels, for the result of the analysis, on putting his ma- 
terials into the crucible. Both hold departments 
within the province of natural philosophy, and truth, 
as it relates to discovery, to its establishment after 
discovery, or' to the correction of pre-existing error, 
should alike be the object of both. 

A writer in appearing before the bar of the public 
should therefore reap a triple advantage from his ex- 
posure, in the communication of truth, in provoking 
a righteous criticism for the mortification of his sins of 
ignorance, and in awakening the attention of the pub- 
lic to desiderata, the solution of which involves prin- 
ciples, which are essential to a lucid and satisfactory 
discussion of his subject. 

Respecting the first object, the communication of 
truth, it is presumed, that the simple collection and 
systematic arrangement of what has been written 
upon these interesting subjects would not be alto- 
gether inutile, particularly to the younger members of 
the faculty. 



VI PREFACE. 

All pretensions to originality the writer entirely 
disclaims. If he have taken acknowledged first princi- 
ples, and applied them by regular induction to the 
discussion of the questions proposed, he can see no 
cause for self-crimination, nor does he discover, that 
the reader should find any for complaint. 

Respecting the accomplishment of the second ob- 
ject a writer should gain in appearing before the bar 
of the public, the author feels more confident of suc- 
cess. Any candid exposition of error in the follow- 
ing dissertations will meet due attention, and the 
error shall be corrected with a becoming readiness. 
The fear of exposing our ignorance implies an un- 
willingness to be instructed, and an unwillingness 
to be instructed ever presupposes a willing- 
ness to remain in ignorance. A man must feel 
the smart of conscious ignorance, or he will never 
cheerfully submit to the privations, to the toil, and 
pain, which are necessary to ensure his success in 
traversing the steeps of science. 

The importance of awakening inquiry to the de- 
siderata in physiology and pathology is too obvious to 
admit of illustration. 

In that species of mortification, which Mr. Pott 
has denominated " Mortification of the toes," usually 
occurring in very aged people, a remedy, which is 
adequate to arresting the progress of the disease in all 
cases is very much wanted. Although Mr. Pott's 



PREFACE. Vll 

name will ever be entitled to honourable mention 
among the faculty, for the successful application of 
opium to the cure of the disease in question, and 
Dr. Physick to the gratitude and respect of every 
practitioner in medicine for the successful application 
of blisters to the cure of the same disease ; still these 
medicines do not act in all cases with a force and cer- 
tainty, entirely satisfactory to the anxious physician, 
upon whom is cast the look of distress, imploring relief. 

The external application of cantharides has been 
proved to be an efficacious remedy in the cure of cer- 
tain species of mortification. Does not the feeble 
state of animation at the time mortification commences 
its attack upon the toes of people, advanced in life, 
call for the internal administration of a medicine as 
powerful as the cantharides? To those gentlemen, 
who have the medical care of infirmaries, hospitals, 
and almshouses, the question is respectfully submitted 
for solution, to be founded upon a variety of judici- 
ously conducted experiments. Any communications 
to the author, which shall reflect light upon this intri- 
cate and perplexing subject, will be gratefully re- 
ceived and duly acknowledged.* It is not impossi- 

* Nitrate of potass has been said to be a valuable article upon the 
list of antiseptics. No mention has been made of it, because no cer- 
tain information could be procured respecting its antiseptic action up- 
on the living fibre. Cicuta has likewise been said to have been admin- 
istered with very considerable success in "gangrene of the toes ;" but 
certain information respecting the mode of its exhibition, and the ex- 
tent of its antiseptic power, was not in my possession. This must 
form my apology for its omission, 



viii Preface. 

ble, that some enquirer after medical truth, more for- 
tunate than his fellows, may already have discovered 
a remedy, superior to any at present generally known, 
in the cure of this often deplorable malady. The 
medical philosopher has done but half his duty in 
completing the discovery, while its communication 
to the public is still kept back. 

In discussing the chemical remedies to be em- 
ployed in the cure of biliary concretions, it may be 
thought too much stress has been laid upon remedies, 
which act without reference to any influence they 
may exert upon the living fibre. Although nothing 
can be received into the stomach without producing 
some effect upon the actions of the living fibre, still 
remedies which have an action more decidedly chem- 
ical than stimulant, the chemical properties having 
the ascendancy, the remedy should receive its title 
from its most prominent qualities. 

Do alkaline medicines, when taken into the stom- 
ach, increase the alkalescency of the bile ? It was the 
intention of the writer to have solved the question by 
an experiment, which would have amounted to de^ 
monstration. It was his intention to have selected 
four pups of the same litter, and to have fed them up- 
on the same kind of food, and in the same quantity, 
to three of which alkalies were to have been adminis- 
tered in as large doses as they could have well borne 



PREFACE. IX 

for a week, each one taking steadily of some alkali, 
but no two of them taking of the same. The ani- 
mals were afterwards to have been killed, and the 
bile of each of them to have been submitted to chem- 
ical analysis, that the constituent principles in the 
bile of the animal taking no alkali might have been 
compared with the constituent principles in the bile 
of those which took of the alkalies, and that the dif- 
ferent constituent principles in the bile of those which 
took of the different alkalies might have been deter- 
mined. 

In this way the fact might have been ascertained. 
This mode of experimenting, which the writer never 
carried into operation from the influence of circum- 
stances beyond his controuJ, is here proposed, that 
the reader, who has the inclination, may prosecute 
the experiment at his leisure. 

In the discussion of the structure and physiology 
of the skin, as preparatory to the treatment of its pa- 
thology, the process pursued by nature in the repro- 
duction of skin, after it is once destroyed, necessarily 
claims our attention. It is a well established fact, 
that the blood is the only material not only for the 
original fabrication of parts, but for their renovation, 
after they are once destroyed. It is a fact equally 
well established, that the qualities of the blood de- 
pend upon the state of the fibre, whose actions are 
concerned in its elaboration from the aliments and 

B 



X P&EJACE. 

drinks taken into the stomach ; and that the actions of 
the fibre, ceteris paribus, depend upon the quality and 
quantity of the aliment and drinks, which constitute the 
ordinary diet. The blood,previously to its chrystalliza- 
tion, or conversion into contractile fibres^ .must undergo 
the process of coagulation. Here inquiry is naturally 
instituted, upon what principle does the coagulation 
of the blood depend : Mr. Hewson thinks he solves 
the question by the aid of reduced temperature, of 
rest, and of exposure to the action of the atmos- 
phere. Although in a great majority of cases these 
agents are apparently sufficient to solve the phenom- 
ena of coagulation, they are insufficient in every in- 
stance to produce the effect. Mr. John Hunter, to 
rid himself of this difficulty, resorted to the vitality 
of the blood, as an immediate agent connected with 
its coagulation ; but, in this solution, he has entang- 
led himself in other difficulties, as inextricable as 
those from which he thinks fortunately to escape. 

Mr. Hunter should not only have proved the real 
life of the circulating blood, but likewise, that its 
powers of life are stronger than those of the fibres, 
whose vibrations commence and maintain its motion ; 
for the living animal may be made to part with its 
principle of animation in many instances, before the 
blood shall be completely coagulated : the life of the 
blood admitted, it cannot be reasonable to suppose it 
-should have lost its vitality, before the process of co- 
agulation is completed. The principle granted, the 



PREFACE. XI 

blood must entirely lose its vitality in the completion 
of the process, because the putrefactive fermentation 
soon follows. In those animals destroyed by light- 
ning, or killed suddenly by other agents, the blood 
cannot be made to coagulate. Do lightning and 
these other agents cause the blood to pass immediate- 
ly from its circulating state to that of putrefaction 
without going through its usual intermediate stages ? 
Putrefaction, it is well known, is very rapid in those 
cases, where the blood cannot be made to coagulate : 
or do lightning, running to death, &c. cause a 
chemical combination to take place between the con- 
stituent parts of the blood, whereas they had previ- 
ously been kept together by simple mixture ? Co- 
agulation, it is well known, is but a separation of 
the blood into its several parts. If a chemical com- 
bination take place between the constituent parts 
from the action of these causes, a question naturally 
arises, what are the new products formed by that 
combination ? 

The disposition of the blood to coagulate is, 
without doubt, intimately connected with the force 
of the vascular action, which maintains its circula- 
tion. Hence every petty phlebotomist pretends to 
measure the degree of inflammatory action by the 
appearance of the coagulum and the time consumed 
in its forming. 



Xll 1? RE FACE. 

Although Hewson and Hunter have done much 
towards explaining the principles regulating the co- 
agulation of the blood, still much, very much remains 
to be investigated, before all the principles concern- 
ed in the process can be satisfactorily applied, by 
the practising surgeon, to the restoration of destroy- 
ed parts. After the coagulation has formed, vascu- 
larity soon commences, and granulations are seen 
elongating into fibres. In the process of skinning, 
Mr. John Hunter says a kind of chrystallization takes 
place. If the blood must undergo a kind of chrys- 
tillization to renovate destroyed organic fibre, then, 
in the solution of the food in the gastric liquor, in 
its elaboration into blood, and in the coagulation of 
that blood to reproduce lost parts, very little morels 
to be seen, than may be discovered in the previous 
solution and subsequent chrystallization of the neu- 
tral salts. At least there is a striking analogy be- 
tween the modes of forming the animal and saline 
chrystal. 

The successful practice of surgery rests entirely 
upon a knowledge of those principles of the animal 
economy concerned in the reproduction of parts, 
which have been once destroyed. The subject 
merits the genius and labours of a second John 
Hunter. 

The pathology and curative treatment of many 
of those obstinate cutaneous diseases, which are the 



PREFACE. Xlll 

scourge of several warm climates, are still involved 
in much obscurity.* There is a combination of 
causes, which prevents such an investigation of 
them, as their importance demands. 

Many physicians who visit those warm climates, 
are more influenced by a love of gain than by a thirst 
for discovery in their professional pursuits. Be- 
sides, the syren notes of pleasure, the tyrant custom, 
and the influence of excessive perspiration for main- 
taining animal temperature at its proper standard, 
palsy those manly powers, which alone can give a 
buoyant support to that indefatigable spirit of in- 
quiry, which penetrates the profound, and unravels 
the mysteries, of disease. Another barrier, still more 
formidable than any of the preceding, opposes an 
accurate discussion of the subject. The people, 
who are afflicted with these diseases, are generally so 
depraved in principle and corrupt in practice, are so 
indifferent to the present and stupid to the future, 
that they cannot be induced to submit to the perse- 
vering use of those means, which are best suited to 
the violence and obstinacy of their complaints. 

Dr. Winterbotham, who was for several years a 
resident practitioner of medicine and surgery at the 
British Factory upon the coast of Sierra Leone, and 

v * They remain to be discussed by Willan ; and the splendid trea- 
tice on Cutaneous Diseases by M. Albinus, a part of which is now in 
the press at Paris, could not be procured. 



XIV PREFACE. 

Dr. Thomas Herberden and Dr. Joseph Adams, 
both of whom were practitioners of medicine some 
length of time upon the island of Madeira, have des- 
cribed, with more accuracy than any other authors 
whom I have had the opportunity of perusing, the 
modern cutaneous diseases of warm climates. But 
they have by no means exhausted their subject; for 
their reader, dissatisfied with their imperfect ac- 
counts of yaws and of elephantiasis, cannot with- 
hold the following inquiries ; answers to which are 
essential to a clear understanding of their nature and 
cure. 

Is yaws an eruptive fever, that runs a certain 
determinate period, after which it invariably de- 
clines, until it is cured by the powers of the consti- 
tution, and what is the length of that period f Now 
far is the disease contagious, and who are most ex- 
posed to its attack ? What are the palliatives, which 
have been proved by experience to be most effec- 
tual in obviating its violence, until it shall have at- 
tained its height and completed its course ? Is the 
constitution ever susceptible to the action of its poi- 
son a second time ? What proportion are destroyed 
by it, in relation to the number cured and to those, 
who are incurable, but eventually fall victims to 
other diseases ? 

Does elephantiasis originate from obstructed 
perspiration in the parts diseased, or from obstruc- 



PREFACE. XV 

lion to the flow of lymph through the lymphatic 
glands in the groin ? In Barbadoes it is called the 
glandular disease from its beginning in the inguinal 
glands. Does the long stagnation of the lymph in 
its vessels produce extravasation and subsequent co- 
agulation, and, in this way, effect the enormous in- 
crease in the thickness of the skin and bulk of the 
limb ? To this opinion Dr. Adams, in his valuable 
treatise On Morbid Poisons, seems inclined. Are 
there no remedies adequate to the removal of this 
glandular obstruction, which admit of internal exhi- 
bition or of external application, the requisite length 
of time to effect a cure ? Is the disease in the least 
contagious ? Are there any, and what are those 
changes of constitution, which are observed to pre- 
cede the attacks of this hitherto uncured disease ? 

The cow-pock, which of late has attracted so 
much attention from the faculty, and from all the 
benefactors of mankind, which is more interesting 
to the lives and health of our race than any discovery 
in the preceding century, which transmits in im- 
perishable characters to the annals of benefaction 
the name of Jenner, merits still further investigation. 
It remains to be determined, whether the real kine- 
pock ever predisposes the system to cutaneous erup- 
tions, and likewise whether the spurious disease op- 
erates any change upon the constitution, that will 
make the true vaccine pustule afterwards exhibit 
different phenomena from those exhibited in consti- 



XVI PREFACE. 

tutions, which have not previously been subjected 
to the actions of the spurious virus. 

The only wish of the writer in stating these de- 
siderata in the pathology and curative treatment of 
these cutaneous diseases is to awaken a spirit of en- 
quiry in such of his readers, as may have the oppor- 
tunity, towards the accurate investigation of what 
long has been involved in an obscurity, as perplex- 
ing to the intelligent and conscientious practitioner, 
as it has been distressing to the unfortunate patient. 

To the Boylston Medical Committee, who have 
affixed to these pages the sanction of their approba- 
tion, the author would apologize for the corrections, 
emendations, and additions he has taken the liberty 
to make, since they passed their hands. No mate- 
rial alterations have however been made in the two 
last dissertations, although they have been some- 
what enlarged. In the dissertation on mortification, 
the most material alterations of the original paper 
were made at the suggestion of its chairman, and 
have since received the private approbation of sev- 
eral of its members. The introductory remarks at 
the commencement of this paper relative to the prin- 
ciples of animation, may perhaps be thought to wear* 
the stamp of originality. If there be any merit in 
them, it is due to the genius and labours of a highly 
eminent physician of our country, whose name I am 
not at liberty to communicate to the public. If 



PREFACE. XVU 

they contain no merit, it must be, because their orig- 
inal clearness has been obscured by their medium of 
communication. In the communication of another 
man's thoughts, particularly if they are the thoughts 
of a great and original genius, and have beenceeeiv- 
ed only in desultory conversation, there is an intrin- 
sic difficulty in the nature of the undertaking, to 
which few are equal, and to which the writer feels 
very inadequate. The obvious importance of the 
principles to a satisfactory discussion of the curative 
treatment of the subject must form his apology to 
the reader for having attempted so much, and the 
difficulty of its execution, to the original mind in 
which they were matured, for having accomplished 
so little. 

Before coming to a close, the respectful ac- 
knowledgments of the writer are due to Dr. Thomas 
Danforth, whose liberal conduct and gentlemanly 
condescension in waving the discussion of one of 
the questions* of last year, after he had nearly com- 
pleted an elaborate paper upon it, will ever entitle 
him to the grateful remembrance and respectful es- 
teem of the author. 

* On the structure and physiology of the skin, with a view to the 
diagnosticks and cure of diseases, usually denominated cutaneous. 



c 



ADJUDICATION. 

WITH the beneficent and laudable view of improving the 
art of Medicine, and to excite practitioners to bring 
those talents to light, which might otherwise be useless to the 
community, Ward Nicholas Boylston, Esq. hath, by an 
instrument under his hand and seal, given to the President and 
Fellows of Harvard College, in Cambridge, bearing date Jan- 
uary 20th, 1803, empowered and enabled that Corporation to 
appoint annually a Committee skilled in subjects connected 
with Medical, Auatomical, Physical, or Chymical subjects, as 
they deem most useful, and the several Authors of the best Dis- 
sertation, (in the judgment of a majority of said Committee) 
upon each of said subjects, which shall be transmitted or de- 
livered to them, on or before the 20th of November next, after 
public notice given of said Questions, are entitled to receive of 
this Committee a Prize Medal (or the amount in money at 
their option), of such value as to said Committee shall seem 
proper ; provided the value of all the Medals distributed, and 
the money thus paid in any one year, sliall not exceed one hun- 
dred dollars. And the corporation having appointed 
ISAAC RAND, M. D. ■ B. WATERHOUSE, M. D, 

Dr. LEMUEL HAYWARD, • AARON DEXTER, M.D. 
JOHN WARREN, M. D. \ Wm. SPOONER, M. D. 
Dr. WILLIAM EUSTIS, \ and 

Dr. JOHN BROOKS. \ Dr. JOSIAH BARTLETT, 

to be a Committee to propound the questions above mentioned, 
and to carry into effect Mr. Boylston's benevolent purpose., 
they do hereby propose the following Questions to all, who 
cultivate Medicine, or the sciences connected with it ; and do 
invite their attention to a discussion of the several subjects 
here laid before them. 



ADJUDICATION. 

QUESTIONS. 

1st. For the best Dissertation on the difference between 
Mortification produced by an external cause, and that which 
arises from a constitutional defect, the diagnosticks, and proper 
mode of treatment of each. 

2d. For the best Dissertation on the structure and physiol- 
ogy of the skin, or external surface of the body, with a view 
to the diagnosticks, and cure of diseases usually denominated 
cutaneous. 

3d. What are causes of the varieties observed in Dysentery, 
and what the method of treatment adapted to the cure of these 
varieties ? 

At a Meeting of the Committee on the Boylston Prize Ques- 
tions, at Boston, December 31, 1806. 

A Dissertation on the first Question relative to Mortifica- 
tion ; and one on the second relative to Dysentery, having 
been read and considered, the question was taken, whether they 
were respectively entitled to the premiums offered, and deter- 
mined in the affirmative. 

On opening the papers accompanying the Dissertation, it 
appeared that the one on Mortification was written by Dr. 
George Cheyne Shattuck, of Templeton, in the county of 
Worcester ; and the one on Dysentery, by Dr. James Mann, 
of Wrentham, in the county of Norfolk. 

Extract from the Record. 

ISAAC RAND, Chairman. 
Boston, January 1, 1807. 

The Printers of this Commonwealth, and in the neighbouring 
States, are requested, for the benefit of medical science, to 
publish the above for three weeks successively in their re. 
spective papers. 



ADJUDICATION. 



AT a meeting of the Committee of Harvard University^ 
for adjudication on the Boylston Prize Questions for 
the year 1807. 

Present, ISAAC RAND, 
LEMUEL HAYWARD, : JOHN WARREN, 
WILLIAM EUSTIS, j THOMAS WELSH, 

AARON DEXTER, \ JOHxV BROOKS, 

JOSIAH BARTLETT, : WM. SPOONER. 
The several Dissertations exhibited within the period spe- 
cified, having been read, and examined, premiums were ad- 
judged to the following : 

On the structure and physiology of the skin, zcith a view 
to the diagnosticks and cure of diseases usually denominated 
cutaneous, designated, cc Temperamentorum instrumentum est 
cutis." The letter accompanying the same, having been exam- 
ined, was found to be the production of George Cheyne 
Shattuck, of Boston. 

On the causes, diagnosticks and cure of biliary concretions, 
designated, " Vestrae petition! respondeo diligenter." The 
letter accompanying the same, having been examined, was 
found to be the production of George Cheyne Shattuck, of 
Boston. 

ISAAC RAND, Chairman, 
Boston, January 4, 1808. 



ERRATA. 

. 75, 1. 21, for phenomanon read phenomenon 
79, 18, alescent r. alkalescent. 
86, 1, add. and imperfect excretion through the insensi 

ble pores of the skin. 
88, 6, for cognocere r. cog-noscere. 
102, 4, Previous r. Previouslv. 
107, 18, fibrile r. febrile. 

23, do. do. 

110, 18, variola r. varicella. 
120, 22, porta r. portce. 

25, do. do. 

137, 24, hepatius r. hepaticus. 
148, 13, conantric r. concentric. 

150, 19, porta r. portie. 

151, 24, upon r. upon. 

163, 6, considerable r. considerably 

170, 15, fb r, for. 

175, 2, articulors r. articulos. 

190 4 11, Junior is r Juniores. 



CONTENTS. 

ON the difference between Mortification produced by an 
external cause, and that which is produced by constitutional 
defect, the diagnosticks and proper mode of treatment of 
each ----- puge 25 

On the Structure and Physiology of the Skin with a view to 
the diognosticks and cure of diseases usually denominated 
cutaneous - 69 

On the causes, diagnosticks, and cure of Biliary Concre- 
tions. - - - - - -119 

Explanatory Notes - - - - 159 



DISSERTATION 



THE DIFFERENCE BETWEEN MORTIFICATION PRO- 
DUCED BY AN EXTERNAL CAUSE, AND THAT 
WHICH IS PRODUCED BY A CONSTITUTIONAL 
DEFECT, THE DIAGNOSTICKS AND PROPER MODE 
OF TREATMENT OF EACH, 



Animal life may be defined a certain power to 
act, which is every where diffused throughout the 
animal machine. Mortification, or the death of a 
part while the rest of the system retains life, is a 
complete loss of this power in the part mortified, 
and a consequent entire cessation of vital action in 
all its vessels. In order to comprehend the means 
best adapted to the support of life and to the restor- 
ation of the body to health, when so direct an attack 
as ♦mortification is made upon it, previous discus- 
sion of animal life and of its various supporters is 
essentially necessary. 

Mortification bears the same relation to the reg- 
ular actions of the healthy animal economy as dark- 
ness bears to light ; and as well might the man, 

D 



26 A DISSERTATION 

blind from his birth, point out the means of obviat- 
ing darkness, as the physician, ignorant of the prin- 
ciples of animation, prescribe for the cure of morti- 
fication. 

The human body is composed of bone, carti- 
lage, muscle, tendon, nerve, &x. These several 
parts admit of subdivisions, and these subdivisions 
may again be resolved into their constituent parts, 
The muscles furnish an example in point. Each 
muscle is composed of bundles of fibres, and each 
fibre of its constituent particles. These particles 
maintain certain determinate distances, to which 
they readily tend upon the least displacement. 

The constituent particles of the fibre retain their 
relative position to each other by the electrical at- 
mospheres subsisting between them ; which electri- 
cal atmospheres are preserved by the actions of the 
corpuscles. 

•* 
Too great electrical atmospheres between the 

constituent particles constitute what is generally un- 
derstood by a lax fibre. Too small electrical • at- 
mospheres between the constituent particles consti- 
tute what is generally denominated a rigid fibre, 
Too great electrical or caloric atmospheres sur- 
rounding the particles of the fibre prevent them 
from approximating to that degree requisite to ren- 
der the vibration vigorous. Too small electrical or 



ON MORTIFICATION. 27 

caloric atmospheres surrounding the constituent 
particles of the fibre prevent the degree of expan- 
sion requisite to a vigorous vibration. The cure of 
the unstrung, lax -fibred splenetic by the cold bath 
and the refrigerant tonics, and the cure of the too- 
tightly -strung, rigid-fibred tetanic patient by the 
warm, bath, electricity and the relaxants, furnish 
proofs in point of the correctness of the positions 
above laid down. The electrical or caloric atmos- 
pheres surrounding the corpuscles of the fibre, ei- 
ther by the violence of vascular action or by com- 
munication from without, may be so far increased 
as to dissolve the fibre, when man either evaporates, 
or becomes a caput mortuum. 

A certain degree of cold, whether proceeding 
from the languid actions of the vascular system, or 
applied from without, approximates the constituent 
particles of the fibre, by diminishing in size the ca- 
loric atmospheres surrounding those particles, until 
the actions of the system are entirely suspended by 
the abstraction of the principle essential to its mo- 
bility. 

All the component fibres of the several parts of 
the body are connected in the brain and heart 
through the media of their nerves and vessels. If 
the motions of life are but interrupted in a single 
fibre, the whole system is made to feel it. The 
tickling of the foot with a straw, or of the nose with 



28 A DISSERTATION 

a feather, will produce severe convulsive laughter, 
or cause the most violent sneezing; both of which 
are but efforts of nature to restore the natural ac- 
tions to*parts primarily affected. 

The supporters of life are internal and external, 
both of which are essentially important. The inter- 
nal supporters of life are the aliments and drinks re- 
ceived into the stomach, which operate as stimuli 
upon its excitable fibre, and upon that of every part, 
through which they traverse in the routine of the 
circulations. The external supporters of life are 
the atmosphere, with all the foreign materials it may 
hold in solution, light, and indeed all foreign bodies, 
which ever impress either of the senses. The mo- 
tions of life are most vigorous, when the force of 
the internal and external stimuli is most nicely ad- 
justed to the excitable state of the animal fibre. 
The economy of animation consists in varying the 
several stimuli, which are its supporters, to the va- 
rying excitability or sensibility of the animal fibre. 
Different parts of the body possess different suscep- 
tibilities to the action of the same stimuli, and the 
same f>art to the action of the same stimuli at differ- 
ent periods of life, and under different circum- 
stances at the same period of life. The sensibility or 
excitability of a part is in an inverse ratio to the 
force of the several stimuli, which have been ap- 
plied to it — Thus the sole of the foot, which in the 
person that never walked, shall have as much sensi- 



ON MORTIFICATION. 29 

bility as the skin upon any part of the body, in the 
hardy pedestrian, long accustomed to travel with 
uncovered feet, shall possess little more sensibility 
than the hoof of the horse ; likewise the eye, which 
never received a ray of light, upon the removal of 
its cataract will be pained excrutiatingly by the 
beams of the sun. 

Different parts of the body will therefore possess 
different powers of life according to the different 
previous exposures of their excitability to the action 
of the various stimuli concerned in its support. 

The feet, which are exposed to greater vicissi- 
tude in temperature, and to the action of more me- 
chanical stimuli, than most other parts that are situ- 
ated nearer the source of the circulations, must ne- 
cessarily be most exposed to the attacks of mortifi- 
cation. When the system labours under severe fe- 
brile disease, and the powers of animation seem al- 
most exhausted, a sinapism or a blister may cause 
the parts, to which they are applied to change their 
colour, turn flaccid, and assume all the appearances 
of gangrene. In such a case mortification is pro- 
duced in that particular part, before death has gener- 
ally taken place, in consequence of the exhaustion of 
its excitability by the stimulu^)f the flies or of the 
mustard seed. When the motions of life in a part 
have been once so completely interrupted as to have 
become incapable of being re-excited, the rest of 



30 A DISSERTATION 

the system takes the alarm, rallies its shattered 
forces, and maintains a combat with the inanimate 
portion, until it either expels it from the surround- 
ing sound parts, or falls with its enemy to resume 
its original circulations with the rest of dead matter. 
In this case decomposition takes place in the morti- 
fied part from the increased caloric atmospheres 
furnished by surrounding matter to the particles of 
the part mortified ; it being an established law of 
chemistry, that bodies in passing from the solid to 
the fluid, from the solid to the aeriform, or from the 
fluid to the aeriform state, invariably absorb caloric 
from surrounding substance. During the putrefac- 
tive fermentation, a great proportion of what was 
originally solid is converted into vapour. 

This is the routine pursued by mortification 
whether proceeding fronf constitutional defect or 
from an external cause. The principal characteris- 
tic difference between the two kinds of mortification 
consists in the different states of the system, when 
attacked by the same disease, originating, from dif- 
ferent sources. When mortification takes place 
from an external cause, it is presumed, that the 
system was in a healthy state at the time the cause 
producing it commenced its operation; whereas, 
when mortificationgcomes on from constitutional 
defect, it is implied, that the general health of the 
system had been previously impaired. The differ- 
ence between the two species of mortification will 



ON MORTIFICATION. 31 

be best understood by a separate discussion of each 
branch of the subject in detail. 

1. Mortification from constitutional defect pre- 
supposes the operation of certain causes to impair 
the power of vascular action in the part mortified. 
Its being attended with two states of arterial excite- 
ment requires a subdivision into 1. Mortification 
from constitutional defect attended with increased 
arterial action, and 2. Mortification from constitu- 
tional defect attended with decreased arterial action. 

1st. Mortification from constitutional defect at- 
' tended with increased arterial action may be pro- 
duced either by an excess of stimulus applied to the 
irritable fibre of the part mortified, or by a deficien- 
cy of stimulus applied to the irritable fibre of the 
part mortified. The treatment being precisely the 
same from whichever cause originating, it becomes 
unnecessary, in a practical point of view, to main- 
tain the distinction. 

The different susceptibilities of different parts of 
the body to vital motion, from the different stimuli 
previously applied to them and from their different 
distances from the source of the circulations, are 
proved in the history of the disease the ancient Ro- 
mans called podagra. Free living and the liberal 
use of generous wine will first cause an interruption 
to the motions of life in the great toe ; whereas the 



32 A DISSERTATION 

food and the wine, which were the predisposing 
causes of the disease, had been first applied to the 
stomach. The great toe from the servile treatment 
it receives must have a portion of its excitability- 
battered down by the mechanical stimuli, which are 
almost constantly acting upon it. From the dimi- 
nution of its excitability, its vessels must possess 
less power to propel forward their circulating con- 
tents, especially when the blood is their only stimu- 
lus for the maintenance of their actions. Languid 
circulations favour the deposition of the tartar of the 
wine and of the earthy parts of the blood in the 
minute vessels. These concretions become the 
sources of painful irritation and of violent inflamma- 
tion, which continue, until the minute vessels have 
absorbed and reconveyed into the circulating system 
all the foreign matter, or until the sensibility of the 
part is completely destroyed. 

Likewise in inflammation which precedes and 
accompanies this species of mortification, there is 
first a deficiency of power in the minute vessels of 
the part mortified to propel forward their circulating 
fluids. 

This favours the deposition and coagulation of 
the lymph, which may become the source of painful 
irritation, that will continue until the corpuscles of 
the fibre become so far distanced by the violent vas- 
cular reactions excited for the removal of the ob- 



ON MORTIFICATION. 33 

strticting cause as to render the iibre incapable of 
further vibration, when the parts thus inflamed 
change their colour from a deep red to a dark pur- 
ble, become flaccid, and lose all their sensibility* 
This obstruction to the flow of arterial blood 
from the surrounding sound parts necesssarily fills 
the arteries of those parts with blood ; and this in- 
creased fulness of the arteries necessarily increases 
their actions from the increased quantity of stimulus 
applied to their irritable fibres. This increase of ar- 
terial action, if it be allowed to proceed too far, will 
extend the mortification. It will generate caloric in 
such quantities as so far to increase the distances 
between the corpuscles of the fibres as to destroy 
their power of vibration. There is another princi- 
ple which demands discussion in the treatment of in- 
flammation besides increased arterial action. 

Mechanical stimuli, as walking, running, labour, 
&c. increase the force of arterial action, but excite 
no inflammation. In the healthy animal economy 
all the vessels, whether of circulation, absorption, 
secretion, or excretion, are nicely balanced in their 
respective actions. An increased action in the one 
set of vessels, which shall be attended with a corres- 
ponding increased action in the other sets of vessels, 
will produce no derangement in the functions of 
health. It is necessary that the balance of action be- 
tween the different vessels be destroyed to excite in- 
flammation. In that inflammation, which precedes 

E 



34 A DISSERTATION 

and accompanies this kind of mortification, the veins 
and absorbent vessels discover a want of action, 
which is in some degree proportional to the increas- 
ed force of arterial vibration. 

In the cure of mortification attended with in- 
creased arterial action, which originates in constitu- 
tional defect, there are two indications to accom- 
plish. The one consists in the reduction of arterial 
action, and the other in the increase of venous and 
lymphatic absorption. The accomplishment of these 
two indications restores that balance of action, which 
constitutes exemption from disease. 

The increase of venous and lymphatic absorp- 
tion implies a diminution in the force of arterial ac- 
tion, for the accumulation of blood in the arteries, 
which increases their actions by increasing the quan- 
tity of stimulus applied to their irritable fibres, is 
produced by a diminution of venous and lymphatic 
absorption. Increased arterial action generates an 
increase of caloric, which increase of caloric must 
necessarily increase the caloric atmospheres sur- 
rounding the corpuscles of the fibre. These in- 
creased caloric atmospheres surrounding the cor- 
puscles of the fibres must necessarily increase their 
mobility, provided they are not carried to such a 
distance as to be removed beyond the sphere of 
each other's influence ; and likewise thin the blood. 
The increased mobility of the fibre from inflammation 



ON MORTIFICATION. 35^ 

is proved by the exquisite pain, which the least irri- 
tation shall excite in an inflamed part, sensibility al- 
ways being implied in pain, and mobility in sensi- 
bility. 

A certain increase of arterial action is absolutely 
necessary to the cure of mortification, but this may, 
and often does, proceed to a dangerous extreme ; in 
which cases it requires moderation. The position 
respecting the necessity of an increase of arterial ac- 
tion in the cure of mortification is proved in the his- 
tory of the sloughing process carried on for the re* 
moval of the dead portions of flesh. 

In the sloughing off of dead portions of flesh 
from the neighbouring sound portions, the arteries in 
the neighbouring sound portions are necessarily in- 
creased in the force of their vibrations. The * co- 
agulable lymph in all cases of healthy inflammation 
becomes thinner, which facilitates its entering mi- 
nute vessels, which had previously been filled with 
serum only. There is likewise an enlargement in 
the size of the minute vessels. " The very first act 
" of the f vessels, when the stimulus which excites 



* That the blood is really attenuated in inflammatory disorders, 
when the whitish crust or size appears, is probable from the follow- 
lowing' circumstances ; 1st, it even seems thinner to the eye ; 2d, the 
red particles or globules subside sooner in such blood, than that in an 
animal in health. Experimental Inquiry into the properties of the blood 
by Robert Hewson, page 50. •• 

f Hunter On The Blood, vol. 2d, p. 5. 



36 A DISSERTATION 

" inflammation is applied, is, I believe, exactly similar 
" to a blush. It is, I believe, simply an increase or 
" distention beyond their natural size." 

The coagulable lymph, after protrusion through 
the minute serous vessels to the termination of their 
living parts, gradually coagulates to form the wedge 
of separation and the wall of division between the 
living and dead portions of flesh. It is to the coag- 
ulation of this lymph, that we are to attribute the 
closure of all the vessels to secure the part against 
hsermorrhagy upon the removal of the mortified 
parts from the sound. The force of arterial action, 
requisite to carry forward the coagulable lymph into 
the minute serous vessels for the purposes above 
specified, is what John Hunter calls adhesive inflam- 
mation ; which is the lowest species of the healthy 
inflammations designed by nature for the restoration 
of lost parts. When arterial action shall transcend 
in force the adhesive and suppurative stages of inflam- 
mation, it must be reduced down to, and maintained 
at, the suppurative stage, that the mortified may 
slough off from the living parts, and that the process 
of skinning by granulations may go on for healing 
the external surface of the sore. 

Such are the sympathies between one set of ves- 
sels and the other sets of vessels concerned in the 
maintenance of the circulations, that the same rem- 
edy which shall affect one set of vessels, invariably 



ON MORTIFICATION. 37 

affects more or less all the other vessels. The dras- 
tic purge, which shall increase venous and lymphat- 
ic absorption, almost invariably diminishes the force 
of arterial action. This is evinced in the cure of 
ascites by gamboge when taken as a purge. Ni- 
tre, which shall materially lower the pulse, increases 
the urinary secretions ; which it probably effects by 
promoting lymphatic absorption. 

Blood-letting likewise, which lessens the force 
of arterial action, under proper regulations in cases 
where the inflammatory action shall transcend in its 
effects the point intended by nature in its increase, 
may contribute much towards harmonizing the ac- 
tions of the several vessels. But the strength of the 
system is too much impaired, when attacked by this 
species of mortification, to bear blood-letting in any 
considerable quantity, or the use of drastic purges. 
In some rare instances, where the system shall gen- 
erally exhibit appearances decidedly inflammatory, it 
may be, and sometimes undoubtedly is, necessary to 
use the lancet ; and if the bowels are so constipated 
as not to be operated upon by the common laxative 
cathartics, drastic purges should be used. After 
arterial action shall have been reduced in force to 
the degree of action, constituting suppurative inflam- 
mation, by the use of laxative medicines judiciously 
administered, by abstinence, by rest, and a general 
adherence to the antiphlogistic regimen usually pre- 
scribed in cases of arterial excitement, the system is 



38 A DISSERTATION 

to be maintained at that standard of action by wine, by 
bark, and by a nutritious diet accommodated to the 
state of the fibre . If the stomach be too irritable to re- 
tain the bark in a large dose ; it should be tried in a 
smaller dose ; and if one preparation of the bark pro- 
duce distress, it should be administered in another form. 

When bark in substance cannot be retained by 
the stomach, bark in tincture or decoction may set 
gratefully upon that irritable organ ; and, when bark 
In tincture or decoction uncombined with any other 
substance is ejected from the stomach, the tincture 
or decoction of the bark combined with laudanum 
may be retained without producing any unpleasant 
sensations. The patient may take freely of the acid 
drinks, as vitriol water, &c. according to the degree 
of thirst attending his febrile diathesis. The local 
remedies to be applied to the seat of mortification, for 
stimulating the venous and lymphatic absorbents to 
take up and reconvey into the system of circulations 
the stagnated blood, and likewise to cast off their 
continuous dead parts, are steam, the fermenting 
poultice, and blisters. 

That steam stimulates the venous and lymphatic 
absorbents is evident from the following considera- 
tions. 

1st. The veins and absorbent vessels are situated 
nearer the surface than the arteries, and, of course, 



ON MORTIFICATION. 39 

must be most stimulated by what is applied super- 
ficially. 2nd. In cases of inflamed joints, where 
there is evidently an effusion of coagulable lymph, 
and, in consequence, a loss of the power of motion, 
the application of steam to the joint diminishes the 
size of the tumour, and increases the power of motion. 
3d. Experiment, which is the only sufficient test of 
principle, demonstrates the efficacy of steam in ar- 
resting the progress of mortification ; which it prob- 
ably effects by stimulating the venous and lymphatic 
absorbents to that increased action which restores 
harmony to the actions of the several vessels consti- 
tuting the circulating system, and likewise by ren- 
dering the vibrations of the fibre more vigorous for 
easting off the continuous dead parts. 

In consequence of the diminished actions of the 
veins and absorbent vessels in the living parts sur- 
rounding the mortified, there must necessarily be a 
diminution of caloric. This dimunition of caloric 
must necessarily diminish the disposition of the fibre 
to vibrate. This diminution of disposition in the fibre 
to vibrate is removed by increasing the caloric atmos- 
pheres surrounding its corpuscles. This increase in 
size of the caloric atmospheres, surrounding the cor- 
puscles of the fibre, is readily and conveniently ac- 
complished by the judicious application of steam. 

The steam of vinegar or of ardent spirits is more 
powerfully stimulating than that of water, and con- 



40 A DISSERTATION 

sequently should be preferred in cases of mortifica- 
tion, where the actions of the minute serous vessels, 
near the surface of the parts surrounding the mor- 
tified, are extremely languid. Flannels wrung out of 
heated spirits, vinegar, water, or a hot decoction of 
the white- oak bark, and applied around the parts ad- 
joining the one mortified, furnish a mode very con- 
venient for administering steam. These flannels 
must be removed and supplied by others as often as 
they become cool or dry. 

When these shall have disposed the living parts 
to slough off the dead, they should be discontinued, 
that the common dressings may be applied to the 
external surface of the sore. In the mean time, the 
system is to be supported by stimuli agreeably to 
previous direction. If the excitability of the sys- 
tem have been much worn down by the habitual use 
of the diffusible stimuli, after the first inflammatory 
symptoms have abated, opium, brandy, &c. should 
be used to maintain the force of action requisite for 
the separation of the dead from the living fibre. 

The following case establishes the efficacy of 
steam in promoting the sloughing process fbr the 
separation of mortified parts. 

Mr. B between forty and fifty years old, 

who had long been a free liver, upon exposing him- 
self in an open boat to a temperature considerably be- 



ON MORTIFICATION. 41 

low his standard temperature, was attacked with 
pain and inflammation in the right leg, which soon 
assumed all the appearances of an incipient gangrene. 
Bark in tincture and the antiseptics in common use 
were administered to arrest the progress of the dis- 
ease ; but were ineffectual in their operation, the 
stomach being too irritable to retain bark in that 
form. The tincture of bark combined with lauda- 
num was then prescribed, and, in that state of combi- 
nation, it set well upon the stomach. Flannels 
wrung out of hot spirits were applied to the living 
parts surrounding the mortified, and changed as of- 
ten as they became dry. The steam exhaling from 
these, additional to the tonics used and a nutritious 
diet, produced the desired separation of the dead 
from the living parts, and thereby effectually prevent- 
ed the spread of the disease. Many other similar 
cases, in which the virtues of steam, have been equal- 
ly well tested and with similar results, might be ad- 
duced, were it necessary. 

The fermenting poultice forms an application 
peculiarly suited to the state of the fibre in parts ad- 
joining those mortified. It stops the progress of 
mortification by stimulating the living parts to a 
more vigorous action for casting off* the surrounding 
dead parts. The carbonic acid gas, with which 
the fermenting poultice is abundantly impregnated, 
tends likewise to correct the stench of putrefac- 
tion *, which it probably effects by combining with 

F 



42 A DISSERTATION 1 

the ammoniacal gas eliminated from the parts pass- 
ing through the putrefactive fermentation and there- 
by forming carbonate of ammonia. 

The common wheat-bread and milk poultice 
medicated with pulverized charcoal is many times a 
valuable external application for the seat of the mor- 
tification. When the inflammation runs high, the 
above poultice should be medicated with lead-water. 
The poultices to be applied to the parts surrounding 
the mortified may often be advantageously medi- 
cated with the powder or decoction of the white-oak 
bark. The antiseptic virtues of the above poultices 
are too well known to require the report of any cases 
in pre of of their efficacy in the cure of mortifica- 
tion. 

The mineral acids, diluted, or alkaline solutions, 
should be used to wash the parts already mortified 
for destroying the fetor, which is sometimes insup- 
portable, while animal matter is in a state of decom- 
position. 

The Spanish fly not only makes a powerful im- 
pression upon the system generally, but it exerts 
such a peculiar influence upon the absorbent vessels, 
that it is placed high upon the list of absorbent rem- 
edies by many writers upon the materia medica^ 
This medicine in the form of an epispastic was first 
applied to cure mortification by Dr. Physick. As 



ON MORTIFICATION. 43 

this remedy must be considered in many respects a 
novel one, and as this paper may fall into the hands 
of those, who have never had an opportunity of pe- 
rusing an article upon " The use of blisters in check- 
ing the progress of mortification by Philip Syng Phy- 
sick, M. D." (which was published in the Philadel- 
phia Medical Museum, vol. 1st, p. 189, &c), the 
history of the cases of mortification treated with 
blisters by that eminent surgeon is here copied in the 
precise language of the author. 

" The practice of curing erysipelatous inflam- 
" mation by the application of a blister over the infram- 
" ed part originated, as far as I know, with the late Dr. 
* ' Pfeiifer. From having employed blisters in the treat- 
" ment of that complaint with great success, I was in- 
" duced to suppose some years ago, that they might 
" be used with advantage in arresting the progress of 
" mortification. The first opportunity I had of apply - 
" ing a blister with this intention was with Captain 
" Stokes, a gentleman between forty and fifty years of 
" age, whom I was desired to visit, in consultation with 
" Dr. Rush, in January, 1803. After an inflammation 
" about the anus, which had been supposed for several 
" years by the patient an attack of the piles, a mortifi- 
" cation was observed to have commenced in the pe- 
" rineum and on the side of the scrotum. At my first 
" visit I proposed the application of a blister, to ex- 
" tend from the edge of the mortification in the perils 
" eum backwards over the buttocks ; this being agreed 



44 A DISSERTATION 

" to, was immediately applied ; the following day, 
" when the blister was dressed, we both were well sat- 
" isfied with its effect, as it had prevented the mortifi- 
tc cation from spreading backwards ; but so extensive 
" was the mortification of the skin and anterior part of 
" the scrotum, which appeared to extend upwards in 
u the course of the spermatic chords towards the abdo- 
" men, that his recovery was not to be expected. Af- 
u ter a few days he died. Dr. Rush being struck with 
" the good effect of a blister in the preceding instance, 
" has lately employed the remedy in a case of mortifi- 
" cation, the history of which is contained in the fol- 
u lowing letter." 

"Dear Sir, 
" I was called upon by Dr. Bleight on the 29th 
" of last July to visit with him Captain R. A. who in 
" consequence of applying a handful of polygonium 
" persicaria, instead of paper, to a common use after 
" going to stool, was affected with an inflammation in 
" the extremity of the rectum, which extended around 
" the adjoining parts, and along the perineum so as to 
" affect the integuments of the scrotum. Bleeding and 
" other depleting remedies had been used to no pur- 
" pose in order to cure it : a partial mortification had 
" taken place. I concurred with Dr. Bleight in ad- 
" vising leeches to the sound parts ; and recollecting 
" the high terms in which you spoke of the efficacy of 
" blisters in preventing the progress of mortification in 
" the case of Captain Stokes in January 1803,1 advised 



ON MORTIFICATION. 45 

" their application to all the diseased parts, which had 
' ' not put on a gangrenous appearance. They had the 
" wished-for effect ; the mortified parts were after- 
" wards cut away, or gradually sloughed off; and, un- 
" der the faithful and patient subsequent attendance of 
" Dr. Bleight, the captain happily recovered and now 
" enjoys his usual health. In the most dangerous 
" state of the disease we gave him bark ; but its dis- 
" tressing effects upon* his system obliged us to lay it 
" aside. 

" From, dear Sir, your sincere friend, 
"Benjamin Rush. 
"Dr. P. S. Physick. 
" Nov. 15th, 1804." 

"On the 24th October 1804, I was desired to 
" meet Doctors Wistar, S. P. Griffits, and Stratton 
" in consultation concerning the^case of Mr. Charles 
" French, who was afflicted with a mortification of 
" the foot, which was advancing daily upwards, un- 
" checked by the liberal use of the bark. On the 
" 27th October I proposed the application of a large 
" blister around the leg below the knee ; this being 
" agreed to, was applied in the evening ; when 
" dressed the next morning, it was observed the 
" mortification had not increased ; encouraged by 
" the benefit derived from it, I proposed on the 29th 
"the application of a second blister to cover all the 
" living parts below the edge of the first ; this blister 
" also rose well ; in a few days a distinct line of sep- 



46 A DISSERTATION 

" aration between the living and dead parts was ol> 
" served ; the blisters were dressed with a mixture of 
" spirits of turpentine and basilicon. I avoid relat- 
" ing further particulars of the case, as Dr. Griffits 
" proposes to publish a circumstantial detail of it. 

" Since writing the above, I have been favoured 
u with the following history of a case from Dr. 
" Church, containing additional testimony in favour 
" of the use of blisters in arresting the progress of 
" gangrene. 

" On Monday of November, I was desired 

" to vist Mrs. Y. in the country, about sixty years of 
il age, of a fair complexion, and delicate constitution : 
" has had several children, and heretofore enjoyed 
"good health. 

" She had been taken on Saturday with frequent 
" chills, with irregular febrile flushings, pain in the 
" limbs and head, which continued increasing for 
" nearly thirty-six hours before I saw- her, when she 
" was delirious, with flushed countenance, irregular- 
ity frequent and tense pulse, tongue furred, respira- 
" tion frequent, with great general uneasiness. 

" The loss often or twelve ounces of blood, with 
" a saline cathartic, abated in some degree the fibrile 
" symptoms. The delirium still continuing in the 
a evening, blisters to the wrists, with a continuation 



ON MORTIFICATION. 47 

<c of\the saline mixture, produced an alleviation of 
4i all the symptoms, so that towards morning she had 
" a few hours sleep. 

" When she awoke, she was perfectly collected, 
"complaining of great soreness in her body and 
" limbs, particularly in one ankle which she said was 
" painful ; her skin was cool, and her pulse frequent 
" but soft, easily yielding to the least pressure. The 
" family informed me, that the ankle she complained 
" of had had an ulcer on it for fourteen years, which 
" had been brought on by a slight injury after one of 
" her deliveries ; that it had within the last two weeks 
" been healed. On examination the ulcer appeared 
" to have been of the size of a dollar, above the in- 
" ternal ankle, which was now quite livid, with some 
" swelling around the edges, having the appearance 
" of a vesication, and a deep purple blush, extend- 
" ing an inch or two beyond it, attended with a dis- 
" tressing, burning sensation. The leg at this time 
" was quite cool and somewhat swelled. The mecl- 
" icines she had been taking were omitted, and the 
" tonic cordial plan substituted ; bark, wine, and 
" opium were administered freely, and cataplasms of 
" bark with yeast were applied to the part, and chang- 
" ed frequently. This treatment was followed until 
" Thursday with an increase of the lividity and ve- 
" sications on different parts of the ankle, filled with 
" a bloody-coloured fluid. On Thursday the ap- 
" pearances were indeed unpleasant ; the lividity of 



48 A DISSERTATION - 

" the ankle had extended, and the deep purple col- 
" our of the skin was near the middle of the leg, with 
" very great tumefaction. The pulse was frequent, 
" the skin cool, tongue dry, and much apparent in- 
" sensibility of the limb. The bark was continued 
" internally, and the fermenting cataplasm of pow- 
u dered carbon, with meal, honey and yeast was ap- 
" plied in large quantities over the part affected, and 
" was repeated or changed very frequently. This 
" plan was rigidly adhered to all Thursday and Fri- 
" day, changing the bark (which had now been taken 
" in such quantities as to sicken the stomach) for 
" some other tonic. 

" The deep and burning redness still however 
u progressed towards the knee with an increase of 
" those unpleasant vesications ; the pulse on Satur- 
" day was much more frequent ; the skin cool ; 
" tongue dry, and covered with a dark coloured 
" crust ; very great restlessness, with a constant in- 
" coherent muttering. 

a In this situation I recollected a conversation I 
" had had sometime since with Dr. Physick, in 
" which he mentioned the good effects he had ex- 
" perienced from blistering in a case of gangrene. 

" The critical and dangerous state of the patient 
" required something to be promptly done. The 
u blister was proposed with considerable hesita- 



• N MORTIFICATION. 49 

" tion, as I could not recollect in what stage or what 
" species of gangrene Dr. Physick had used it. 

" A large blister was however applied on the in- 
u side of the leg below the knee, one part on the 
" healthy portion of the leg, and the remainder im- 
" mediately on the diseased part. After twelve 
"hours it rose very well, and, contrary to what I 
" dreaded, assumed a very pleasing aspect, and with- 
" out the least increase of disease. The pulse still 
" continued frequent and the skin cool, although the 
" patient in every other respect was much more com- 
" posed — On Sunday the leg was much more fa- 
" vourable ; the lividity and vesication had not in- 
" creased, and the tumefaction, which was very con- 
" siderable, had subsided much. The foot though 
"much swelled before, did not until this period, 
'* shew the least disposition to take on diseased ac- 
" tion. It now became covered with a deep purple 
" shining appearance, with a distressing vesication, 
"which, together with the increased tumefaction, 
"occasioned much uneasiness. The bark, with 
"elixir of vitriol, was persevered in freely, and, 
" from the pleasing effects of the blister in arresting 
f. the progress of the disease in the leg, I applied 
" a large one covering all the upper part of the foot, 
" including that part of the ankle where the disease 
" first began. 

S 



50 A DISSERTATION 

" The effects were equally as pleasing as in the 
" first instance, producing an almost immediate ces- 
" sation of the progress of the disease. 

" The parts of the ulcer, where the disease first 
" began, separated to some depth ; the cuticle from 
" below the knee separated, and in some places on 
4 'the leg; and the separation extended even through 
" the cutis and adipose membrane. The tumefaction 
"of the leg gradually diminished, and the patient is 
" completely free from every danger. 

" Impressed with an idea that blisters will often 
" be found useful in preventing the progress of 
" mortifications, I have been induced to publish the 
" preceding cases as early as possible. 

"Philip Syng Physick. 

" Philadelphia, 24th November, 1804." 

II. Mortification from constitutional defect at- 
tended with decreased arterial action, usually first 
discovers itself in an increased redness and sensibil- 
ity of the part primarily affected. The sensibility 
oftentimes increases, until the pain becomes ex- 
cruciating. From this severe pain and deep red 
colour, the part affected passes to a livid hue and to 
a state of complete insensibility. The powers of 
animation are so extremely languid in their opera- 
tion, that the increased sensibility and redness, fol- 
lowed by a dark purple colour and insensibility, 



ON MORTIFICATION. 51 

progress, until life is attacked too near its source 
to be able longer to resist the encroachments of 
death. The typhus pulse, usually attendant upori 
this kind of mortification in its first and second 
stages, at length becomes intermittent and convuls- 
ed, when it beats the alarm of death — and stops. 
This is the course pursued by the disease, when the 
cure is left to the operations of nature. 

The principal indication to accomplish in this 
case is to render the vibrations of the fibres, in the 
parts contiguous to the mortified, sufficiently vigor- 
ous in their alternate relaxations and contractions to 
break their hold upon the dead parts, and thereby 
dispose them to fall off. 

The remedies to be used in effecting this are in- 
ternal and external. The internal comprise, 1st. 
cordial drinks and aliments, 2d. the tonic and as- 
tringent barks, and, 3d. the diffusible stimuli. 

1st. The aliments taken should be as stimulat- 
ing as the stomach can bear. If the stomach be not 
too irritable to receive solids, animal food highly 
seasoned with mustard, pepper, and salt, should be 
taken — highly seasoned broths or soups, impregnat- 
ed with aromatics, as cloves, &c. may also be taken 
according to the state of the patient's stomach. 

The cordial drinks should consist of vitriol wa- 
ter, generous wine, &c, which should be used with 



52 A DISSERTATION 

much freedom. Well preserved cider impregnated 
with large quantities of the carbonic acid gas, and 
the best London porter may likewise be used with 
much advantage. 

2d. The tonic and astringent barks compre- 
hend cinchona, white-oak bark, the bark of the 
Spanish oak, &c. In this kind of mortification, the 
cinchona, or Peruvian bark, should be administered 
in as large doses as the stomach can well bear. 
According to Mr. B. Bell the pale bark is much the 
most efficacious. 

Dr. Physick in one of his lectures upon mortifi- 
cation, in his course of 1806 — 7, related a case from 
the annals of his own practice in which bark from 
Bvi to §viij was administered in the space of twenty- 
four hours without its exciting any very unpleasant 
sensations. 

The bark, which has long stood at the head of 
the list of antiseptics, in this case, although admin- 
istered in such large quantities, produced not the 
least good effect in stopping the progress of the 
mortification. According to my best recollection, 
Dr. Physick observed, that the disease finally yield- 
ed to blistering. 

Mortification of the toes, as it occurs in aged 
people, frequently furnishes examples, wherein bark* 



ON MORTIFICATION. 53 

in however large doses it be administered, and how- 
ever often their repetition, is attended in its opera- 
tion with similar ill success. In many instances 
Mr. Pott cured mortification of the toes with opi- 
um, after the bark had been unsuccessfully tried. 

Cortex quercds albte, white-oak bark, possesses 
great astringent and very considerable tonic virtues. 
From the chemical nature, and effects of this medi- 
cine taken internally, it may with propriety be plac- 
ed high upon the list of tonic remedies under the 
class of antiseptics. In one case of erisipelas, 
which threatened immediate mortification, I have 
seen it,' conjoined with an external application to the 
part inflamed, have a most salutary operation in 
strengthening the system, and subduing that kind of 
diseased action, which had it not been seasonably 
restrained by medicine, must inevitably have termi- 
nated either in partial mortification, or the entire 
death of the patient. 

The bark of the Spanish oak, quercus rubra 
montana of Marshall, red-oak of the mountain, is said 
by Dr. Barton, in his Collections for an Essay* to- 
wards a Materia Medica of the United States, to 



* It may not be amiss here to inform the reader, that this short 
treatise is a valuable repository of facts respecting the medicinal pro- 
ducts indigenous to our own soil ; and as comprising all, or nearly all* 
at present known upon that interesting subject, it cannot be too highly 
recommended to his perusal. 



£4 A DISSERTATION 

have wrought a complete cure in a case of gangrene, 
which occurred within the sphere of his practice at 
Philadelphia. The following is his history of the case. 

" In a case of gangrene of the foot, from a punc- 
" ture of a nail, which came under my notice in the 
" course of the last summer, I gave to the patient 
" very large quantities of the decoction of this oak- 
" bark ; at the same time that the affected part was 
" constantly kept wet with the same decoction, or 
'* with a poultice made of bread and milk with the 
" bark. I cannot but ascribe the recovery of my 
" patient entirely to the use of these means ; and I 
" am emboldened to repommend to my country- 
u men the use of this cheap remedy, as one highly 
" worthy of their attention in similar cases." Part 
1st. p. 44. Col. for &c. &c. 

The medical virtues of this, if not the same, are 
probably in no respect materially different from 
those of the bark of the common white -oak of New- 
England ; as they both belong to the same family of 
plants, and both have been found beneficial in the 
cure of diseases, differing rather in degrees of force, 
than in their natures. White-oak bark exceeds in 
astringency the Peruvian, and falls but little, if any, 
short of it in its tonic powers. 

A chemical analysis of the white -oak bark, as 
made by Mr, Davy, affords from one hundred and 



ON MORTIFICATION. DJ 

eighty grains of the inner bark in substance seven- 
ty-two grains of pure tannin. In 128th page, vol. 
8th. Fourcroy's Chemistry, William Nicholson, 
London, 1804, is the following description of tan- 
nin — " There is every reason to believe, that this 
" very remarkable vegetable principle," i. e. tannin, 
" is the common and general source of the astringent 
" property ; that it is the principal seat of the vir- 
"tue, which the physicians call antiseptic, &c." 

III. The diffusible stimuli are opium, brandy, 
and ardent spirits of all kinds, the volatile alkali, &c. 
Opium seems to be more peculiarly adapted to the 
cure of mortification originating in the toes, than 
any other remedy hitherto discovered, if we except 
blistering. So important are deemed ihe virtues of 
opium in the cure of this kind of mortification, that 
the highest eulogiums have been heaped upon Mr. 
Pott, who first applied the article to the cure of the 
disease in question. 

That it produce the desireo^ effect, it is necessa- 
ry that it be administered in such doses, and those 
doses repeated at such intervals, as will constantly 
keep the system under the influence of its stimulus, 
and thereby take off that extreme sensibility, which 
renders the pain so excruciating. Brandy, rum, 
&c. should be used very freely by those, who have 
long been accustomed to the stimulus of those arti- 
cles, or who have become s© extremelv debilitated 



56 A DISSERTATION 

as to have lost their susceptibility to the influence of 
ordinary stimuli. In cases requiring the use of the 
diffusible stimuli, the dose and its repetition should 
be so regulated as to render the excitement of the 
system uniformly increased ; otherwise the remedies 
may fail to afford the desired relief. The volatile 
alkaline salts should be administered, whenever the 
powers of the system shall be so exhausted, that less 
powerfully stimulating medicines cannot excite its 
actions. 

The external remedies to be employed in the 
cure of mortification from constitutional defect at- 
tended with decreased arterial action, are the same as 
those, which were enumerated in treating upon the 
cure of mortification from constitutional defect 
attended with increased arterial action. 

In this species of mortification, however, the 
steam to be applied to the seat of the disease should 
proceed from an elevated temperature of very pow- 
erfully stimulating articles. Heated vinegar or ar- 
dent spirits furnish steam powerfully stimulating, as 
do likewise the heated decoctions -of many of the as- 
tringent barks, &c. The astringent principle may 
dispose the fibre to contract, while the flow of caloric 
from the steam to its corpuscles gives it the power 
of elongating. The fermenting poultice may some- 
times be applied with advantage, but is generally 
too inefficacious an application to be employed, when 



ON MORTIFICATION. 57 

the powers of animation are so nearly exhausted. 
Blisters to extend around the living parts surround- 
ing the mortified, the practice of Dr. Physick has 
proved very efficacious in the cure of this species of 
mortification. The application of the most power- 
fully stimulating steam should precede that of the 
blisters. If the parts be too inirritable to be acted 
upon by the conjoint forces of the steam and blis- 
ters, they should be washed with diluted sulphuric- 
acid to facilitate the action of the flies. 

Opium administered internally, and blisters ex- 
ternally applied around the parts surrounding the 
mortified, in the manner above specified, are undoubt- 
edly the two most efficacious remedies hitherto dis- 
covered in the materia medica for stopping the pro- 
gress of this kind of mortification. The bark and 
general tonic plan of treatment should by no means 
be omitted, while the system is under the influence 
of these other remedies. If the mortification extend 
so deep as to render amputation necessary, the above 
remedies should be perseveringly used, until the 
deadened soft parts have sloughed off from the sound % 
after which the operation should immediately be 
performed. 

The carbuncle, which often comes on without 
any apparent cause, undoubtedly belongs to the di- 
vision of mortification, not preceded by, or accom- 
panied with, increased arterial action. It most com- 

H 



58 A DISSERTATION 

monly makes its appearance upon the backs of pco* 
pie in advanced life, and when they are numerous 
and extensive, the disease is attended with extreme 
danger* 

It commences its attack with a circular inflam- 
mation at first circumscribed to a point, from which 
it extends, putting on a paler hue, and is accom- 
panied with very severe pain. The common reme- 
dies, employed in the cure of this species of mortifi- 
cation, are proper in the cure of carbuncle. 

Among the notes I took while attending Lec- 
tures upon Surgery by Professor Physick, I find the 
following. 

There is another kind of mortification, which 
comes on without inflammation, and which has 
something very peculiar in its nature. The disease 
first begins with a pain of the shooting kind in the 
part attacked, from which it extends itself in every 
direction. It soon becomes livid, and afterwards turns 
black. The disease is rare in this country, but is 
said to be common in Provence, France. It has been 
successfully treated by making a circular scarifica- 
tion in the sound parts surrounding the diseased. 
The adhesive inflammation excited by the scarifica- 
tion checks the progress of the mortification upon 
its arrival at the line scarified. A solitary case of 
this kind of mortification, which occurred at Phila- 



GN MORTIFICATION. 59 

delphia, was successfully treated by scarification 
made in the above manner. This remedy was used 
at the advice of Dr. Mongez, after the usual reme- 
dies had been applied without success. 

In the London Medical Museum, vol. 1. p. 442, 
Dr. Wollaston gives a very extraordinary account 
of a mortification, which proceeded through a whole 
family at Wattisham. The case, as illustrating the 
importance of a wholesoifie diet to the general health 
of the system and the preservation of its various 
component organs, deserves transcribing. 

In January 1762, John Downing together with 
his wife and six children, were successively attack- 
ed with mortification, which was supposed by the 
attending physician to have originated in the use of 
corrupted meal, which was made into bread for fam- 
ily consumption. P. 445, is subjoined the following 
account, taken from Memoires Hist. torn. 2nd. p. 16. 

" Some years ago M. Perrault gave an account 
" to the accademy of Sciences in Paris, that in pass- 
u ing through the Sologne he heard from the physi- 
" cians and surgeons of the country that the rye was 
" corrupted in such a manner, that the use of the 
" bread into which much of that corrupted grain 
" had entered, caused one part to fall off mortified 
" from some, from others, another ; and, that one, 
" for example,, lost a finger, another his nose, &x* 



60 A DISSERTATION 

w that this gangrene was not preceded either by fe- 
" ver, inflammation, or considerable pain, and that 
" the gangrened parts fell off of themselves, without 
" any need of being separated by applications." 

Although the most skilful surgeon will ever feel 
distrustful of any applications he can make in curing 
mortification, which proceeds from constitutional de- 
fect ; still not only all probable but after their faith- 
ful trial and failure, all possible remedies are to be re- 
sorted to for restoring the patient, and to be persever- 
ingly used so long as the least gleam of life remains. 

II. Mortification produced by an external cause 
may be divided into three distinct kinds according 
to the efficient means concerned in its production. 

1st. When it is preceded by the use, internal or 
external, of poison ; 2nd. When it is preceded by 
exposure to scalding heat or freezing cold ; and 3d. 
When it follows external violence, that immediately 
kills the part sustaining the injury, or so far lacer- 
ates it, or paralizes the contractile power of its ves- 
sels as to bring on inflammation of gangrenous termi- 
nation. Although the medical management of these 
three kinds of mortification proceeding from an ex- 
ternal cause may vary but little, still as the prophy- 
lactics in each are so very different, we shall be justi- 
fied in adhering to this division of the second part of 
our subject. 



•ON MORTIFICATION. 61 

1st. Respecting mortification produced by poi- 
son, it may be observed, that few hopes can be en- 
tertained of effecting a cure, after it has once really 
commenced. Alexipharmics, before the full opera- 
tion of the poison, should be used freely as guar- 
dians against its deadly influence. 

If the poison have been received into the stom- 
ach, emetics of sudden and powerful operation, as 
blue vitriol, &c. should be taken immediately to 
throw it up and counteract its influence. When it 
is impracticable to effect this by emetics, before the 
poison has partially operated, and, if it already has 
excited puking, copious draughts of demulcent 
drinks at a temperature lukewarm should be taken 
to dilute it, and prevent its corroding or paralizing 
the coats of the stomach by facilitating its ejection 
from that organ. Dr. Bancroft, of Middlesex county, 
communicated to me the following fact, which he 
witnessed within the circle of his own practice. A 
man through mistake had taken fifteen grains of cor- 
rosive sublimate at once, which excited the most 
violent puking and spasm. Large draughts of milk 
and water were drunken, which so far diluted this 
mineral poison and assisted its being thrown up from 
the stomach, that the patient in a few days was com- 
pletely recovered from its operation. If the poison 
have commenced its action upon the intestines, ene- 
mas of castor oil, or of olive oil, should be adminis- 
tered repeatedly, and in quick succession to acceier- 



62 A DISSERTATION 

ate the passage of the poison through the body. 
The same articles may also be administered internally 
in very large doses. If the poison have proceeded 
so far in the work of death before assistance is 
sought as to have destroyed consciousness and to 
have reduced the body to a palsied state, it is possi- 
ble that the affusions of cold water upon its surface 
or the long continued application of powerful me- 
chanical stimuli may rouse the system, while the 
requisite internal remedies are administered. The 
poison of rum> which has destroyed thousands, 
where that of asps has killed one, is defeated in its 
influence by the plentiful affusion of cold water upon 
the surface of the body. The drunkard in his fit of 
intoxication, upon having cold water pumped over 
his body, awakes from his apoplectic stupor, and 
rises from the ground to resume his usual occupa- 
tions. Whytt relates a case in proof of the salutary 
influence of mechanical stimuli in rousing animals 
from the stupor induced by poisonous drugs taken 
into the stomach. A dog, which had swallowed a 
quantity of opium apparently sufficient to have killed 
him, was roused from a state of insensibility by a 
severe flagellation. 

If the poison taken be of an alkaline nature, min- 
eral and vegetable acids are the proper antidote ; 
and, vice versa, if the poison be of an acid kind, the 
vegetable or mineral alkali in strong solution should 



ON MORTIFICATION. 63. 

be taken to destroy its corroding powers by neutral- 
izing the acid. 

If an animal poison have been applied to the ex- 
ternal surface of the body, any of the caustic appli- 
cations to succeed scarification will 'corrode away 
the part poisoned, and destroy the effects of the 
poison, provided the lapse of time between the ap- 
plication of the poison and that of the caustic have 
not been too great. Calomel, as an internal remedy 
and mercurial unguents, applied externally, will some- 
times secure the system against the action of the 
poison. A few instances in proof of the alexipharmic 
virtues of nitrate of silver externally t applied, and 
mercury taken internally, have occurred within the 
limits of my personal acquaintance. In one case the 
scarification of the part bitten by the rabid animal, 
and the subsequent application of lunar caustic to it 
effectually prevented any alarming symptom from 
the operation of the poison. In another, the patient, 
from a slight cut of the finger in dissecting, was af- 
fected to that degree by the animal juices while un- 
dergoing the putrefactive fermentation, that he was 
afflicted with a severe pain through his whole ^arm 
and shoulder, and an inflammation that threatened, 
immediate mortification and final death. Lunar 
caustic was applied directly to the place cut, and a 
mercurial unguent rubbed over the whole arm in the 
course of the pain and swelling. Calomel was taken 
iBternally, until the glands of the mouth and fauces 



64 A DISSERTATION 

began to be affected. These remedies arrested the 
further progress of the pain and inflammation, and 
effected a cure of the disease* 

Oils, if seasonably applied, are said to be suffi- 
cient prophylactics against the poison of serpents. 
Certain caustic applications, as concentrated sulphur- 
ic acid, &c. experiment has demonstrated to be such. 

2nd. As mortification preceded by excess or de- 
fect of temperature requires medical treatment in no 
respect materially different from that preceded by 
external violence, it hardly merits separate attention. 
We shall only remark that it is rather produced by 
the suddenness than the degree of change as is prov- 
ed in the trifling inconvenience, that commonly at- 
tends the gradual alteration from one to the other ex- 
treme. When there has been an exposure to one 
extreme, the object of the physician should be to re- 
store the part thus exposed gradually to its mean 
temperature. Snow and cold spring- water are the 
proper applications to a part frozen, and spirits of 
turpentine and other warm irritating substances are 
most suitable to be applied to a part scalded or burnt. 
The part scalded or burnt should be exposed, naked, 
to the atmosphere, that the spirits of turpentine may 
undergo a rapid evaporation ; and they should be 
poured as rapidly upon the diseased surface as thdj 
can be made to evaporate for several hours after the 
accident. Spirits of turpentine blended with the 



ON MORTIFICATION. 65 

yellow basilicon spread upon lint makes an exceeding- 
ly good application to succeed the use of the simple 
spirits of turpentine in the cure of burns. This 
remedy I have used with the most satisfactory suc- 
cess. It should not come in contact with any of 
the sound skin, as it is highly irritating to that, al- 
though it excites very little pain in the part diseas- 
ed. This remedy is very highly recommended by 
Kentish on Burns. 

3d. The third division of this second part of our 
subject embraces the diagnosticks and cure of morti- 
fication following external violence, that lacerates, 
bruises, or, in some manner so far deranges the 
structure of certain portions of the system, as either 
suddenly destroys the life of the part, or brings on 
inflammation of gangrenous tendency or termination. 

In all kinds of mortification, resisting and over- 
coming this tendency in the system to putrefaction 
claim attention rather than the restoration to life of 
parts already mortified . 

The principal difference between mortification 
from constitutional defect and that which proceeds 
from an external cause is to be found, as has already 
been remarked, in the previous state of the system 
before attacked by the disease. When any external 
cause, adequate to the production of mortification 
in a healthy constitution, shall have operated, violent 

I 



66 A DISSERTATION 

inflammation supervenes, which, if allowed to proceed 3 
extends until the whole . system is attacked by a fe- 
ver, that eventually may destroy the patient, provided 
no remedies are used to procure its abatement. 
When some great violence has caused this sudden 
transition from full health to partial mortification 
and universal inflammation, the natural suscepti- 
bility of the system to the action of stimuli is so far 
increased as to require great reduction in the force of 
u the exciting powers," acting upon this morbidly 
increased susceptibility. Copious depletion, as 
most readily diminishing the force of these acting 
stimuli, is loudly called upon to afford the desired 
relief. Blood-letting, both general and topical, and 
active, cooling cathartics are the principal remedies 
to effect this reduction in the force of the sthenic 
diathesis ; and these are to be repeated according to 
the prevalence of that diathesis. These violent re- 
actions of the system excited to recover itself from 
the local injury (which reactions constitute the fever) 
may generate caloric in such quantities as so far to 
increase in size the caloric atmospheres surrounding 
the corpuscles of the fibres as to remove them be- 
yond the sphere of each other's influence, when the 
fibres cease to vibrate, and animal decomposition 
begins to take place. Cool air and cold water re- 
duce this excessive temperature, when applied to 
the surface heated above its standard temperature. 
Acetite of lead, or muriate of ammonia, dissolved in 
vinegar and water, makes a good local application for 



ON MORTIFICATION. 67 

the original seat of the inflammation in diminishing 
its excessive actions and conducting off the morbid 
excess of caloric. Abstinence, rest, the abstraction 
of light and of sound, and a free use of cooling dilu- 
ent acid drinks should be rigidly enjoined to co-op- 
erate with the other remedies in regulating the reac^ 
tions of the system, that the time, requisite to the 
completion of the sloughing process for casting off 
the mortified parts, may be allowed, before death can 
supervene. After the fever has abated, recourse 
must be had to a nutritious diet, to wine, to bark s 
and to other tonic remedies, to maintain the system 
at that standard of action required in the cure of the 
patient. Blisters around the parts mortified, or the 
fermenting poultice, should likewise be used accord- 
ing to the circumstances of the case. Should the 
mortification be so extensive as to render an ampu- 
tation necessary, the operation should be delayed, 
- until the tendency in the system to putrefaction be 
subdued, and there shall be formed a line of distinc- 
tion between the dead and the living fibre. After 
these indications are accomplished, the operation 
should be no longer deferred. 



DISSERTATION 



THE STRUCTURE AND PHYSIOLOGY OF THE SKIN, 
WITH A VIEW TO THE DIAGNOSTICKS AND CURE OF 
DISEASES USUALLY DENOMINATED CUTANEOUS. 

IVIatter is continually circulating. The hardest 
substance gradually becomes fluid or aeriform, and 
substances the most fluid or aeriform are gradually 
becoming solid or fluid. The machinery of the hu- 
man body, which is a compound of solids and fluids, 
is one product of this circulation. In the history of 
man's uterine animation and growth, it is found that 
those parts are first developed, whose actions are most 
essential to the origination, extension and maintenance 
of those circulations, concerned in the arrangement, 
structure and increment of the various organs of his 
body. The uterine blood of the mother, which is the 
raw material to be wrought up in the animal factory, 
imparts its principles of nutrition as it passes, propelled 
by the salient vibrations of the heart, the more tho- 
roughly elaborated particles only being carried to the 
surface. Hence the skin of the foetus exhibits the 
appearance of a very fine pellicle ; but the skin has 



70 A DISSERTATION ON 

few or comparatively unimportant functions to per- 
form, while the body is enveloped in the membranes, 
and continues its attachment to the parietes of the ute- 
rus, where it has a uniform temperature, which nothing 
can destroy without producing its first impression up- 
on the mother. When the foetus drops its maternal 
hold, the skin, as well as lungs, has functions entirely 
novel to perform. In the former situation, preserved 
in a temperature equable and invariable, protected 
from any foreign agent by a bland water, which sur- 
rounded it, the skin apparently had no other duty to 
discharge than remain in a quiescent state to be acted 
upon by an internal pressure from gradually distend- 
ing parts, and an external one from the fibrous contrac- 
tions of the uterus. In the latter situation it is exposed 
to variety of temperature almost invariably below the 
standard of animal heat, to the action of the atmos- 
phere, with that of all the principles it may hold in 
solution, and indeed to the action of all external me- 
chanical agents with which it is liable to come into 
contact. To accommodate itself to its new situa- 
tion, the skin soon undergoes a considerable alter- 
ation. The action of the atmosphere upon it causes 
it to contract, hardens it, and roughens its exterior 
surface. 

The skin is connected with the other soft parts 
by intervening cellular membrane. Its readiness to 
dilate and contract by the action of mechanical agents 
shows its great elasticity. Maceration proves it to be 



THE STRUCTURE OF THE SKIN, 71 

composed of three distinct lamina ', which anatomists^ 
have called cutis vera, rete mucosum, and cuticula. 

The cutis vera is formed of a very thoroughly 
elaborated portion of the blooll, it having been sub- 
mitted to more vascular action than that from which 
other parts nearer the heart are generated. Almost 
the whole strength of the skin is concentered in this 
stratum. It is the part, which receives the principle 
of tannin in making leather. 

The cutis vera, notwithstanding its distance from 
the source of the circulations is extremely vascular. 
No part of it, in a living state, can be divided, with- 
out the effusion of blood. It is the strand, where 
the arterial flow terminates, and the venous ebb com- 
mences. It is the seat of exhalent arteries, which 
secrete and throw off perspirable matter, and is the 
expansive bed, upon which repose the sentient ex- 
tremities of the whole nervous system. It likewise 
is the part, in which are imbedded all the cutaneous 
absorbents. ( a ) The seat of the sense of touch, it per- 
forms offices essentially important to the lives, health, 
and pleasure of animals. It is less exposed from its 
situation to the influence of external chemical or me- 
chanical agents than the other laminae. 

The rete muscosum is the next lamina exterior to 
the cutis vera. It is extremely cellular in its struc- 



72 A DISSERTATION ON 

ture, as its name implies. It is to the complexion, 
what the iris is to the colour of the eye. 

It varies in colour and consistence according to 
climate, state of socie%j and its exposure to the com- 
bined influence of the sun and atmosphere. In civil- 
ized man of middle latitude, it exhibits, when viewed 
by the microscope, the appearance of a mucilaginous 
net- work, less delicate than that in the vitreous hu- 
mour of the eye, though of a lighter colour by several 
shades. In colour it approaches almost to the white- 
ness of the medulla oblongata. In the torrid 2one, 
the inhabitants have black or swarthy complexions, 
from the changes which a perpendicular sun and co- 
pious perspiration operate upon this singularly con* 
structed portion of the skin. 

In proof of the position respecting the skin's 
undergoing a change in function, and of course in 
structure, adapted to the discharge of that different 
function after birth, it will be sufficient to adduce 
the similarity of complexion in the children of the 
white woman and black, when they are first 
born, and the material difference, which discovers 
itself soon afterwards.(B) By microscopical ex- 
amination in a black descended from parents Afri- 
canborn, it exhibited a sky-blue colour. The mu- 
cous meshes appeared somewhat larger, more corru- 
gated, and much firmer in their consistence than 
those in the skin of the white man. 



THE STRUCTURE OF THE SKIN. 73 

The rete muscosum, in colour and appearance, 
exhibits a variety equal to the diversity of climate 
from the line to the poles. It is but a change in 
this, which converts the white man into the black 
man ; which, at the same time it fixes the indelible 
stamp of degradation, enables the constitution to re- 
sist the combined agency of a perpendicular sun and 
a damp atmosphere. A discussion of the opinions 
and arguments of all, who have written upon the 
causes of the variety in the human complexion, would 
swell these sheets to a full- sized octavo. Suffice it 
to say, we stand in no need of different originals for 
the different portions of the human family in ac- 
counting for their variety of complexion.(c) 

The cuticula, called also epidermis, and scarf 
skin, is the external lamina, which comes in contact 
with the atmosphere. It is a fine membrane entirely 
devoid of sensibility ; and its vascularity seems to be 
somewhat questionable ; for while all anatomists agree 
in their inability to inject any vessels belonging to 
it, some think this negative argument against its 
vascularity insufficient to justify the assertion, that it 
has no vessels, while others as confidently maintain 
the opposite sentiment. Though devoid of sensi- 
bility, and probably of vascularity, it is the result of 
organic action, and not a mere mucus hardened by 
the action of the atmosphere as many of the ancients 
supposed. Chemistry can supply nothing analogous 
to it. Microscopically examined in a living state. 

K 



74 A DISSERTATION ON 

it apparently dives down into the rete mucosum^ 
forming it into cells. In this respect it seems some- 
what to resemble the tunica arachnoides in its in- 
velopement of minute portions of the brain. The 
cuticuh is susceptible of quite as great changes in 
structure and thickness from mechanical compres- 
sion and the action of chemical agents as the rete 
muscoswn is from the combined agency of the sun 
and atmosphere. This is evinced by its thickness 
in the palms of the hands and upon the soles of the 
feet of the labourer, and by the scaly appearances of 
the skins of those, who alternately expose their hands 
to the action of air and water. The physiological 
purpose subserved by the scarf skin seems to be the 
protection of the other lamina from the chemical 
and mechanical irritations, the touch of which would 
otherwise be extremely painful. 

The hypothesis of Malpighi respecting the origi- 
nal construction of the skin from the three invelopes 
of the brain by their extension and expansion, their 
order according to him having been inverted after 
passing through the tela cellulosa, that the cutis vera 
might correspond to the dura mater, must be sub- 
stantially untrue, for according to this doctrine the 
nervous papilla should have been exterior to the cu- 
ticukj whereas the fact is directly the reverse. 

The skin is the product of vascular action upon 
circulating blood, being formed by a process mi ge- 
neris, which is incapable of imitation. 



THE STRUCTURE OP THE SKIN. 75 

It has already been stated, that the skin, while 
the child is yet in its mother's womb, is subjected 
to an external pressure from the contracting parietes 
of its matrix. After nature has destroyed its uterine 
attachments, it is exposed to a pressure from the at- 
mosphere, which is equal to fifteen pounds, every 
square inch of superficies. It is not only exposed 
to such a pressure, but to a very material change in 
temperature. The tendency to equilibrium of tem- 
perature in all bodies, from the necessary flow of cal- 
oric from warm into the cool is evinced by the pas- 
sage of a portion of the caloric from the animal into 
the surrounding air. Caloric is the principle of ex- 
pansion in all bodies, and, upon the loss of any por- 
tion of this, contraction is the invariable result 

This accounts for the appearance of the cutis an- 
serina upon the admission of cold air to the naked 
skin. Though the production of the cutis anserina 
be accounted for by the diminution of temperature, 
still there must be the principle of animation to favour 
the agency of cold in the production of this phenomenon* 

The skin, when the foetus passes from its warm 
bed in utero into the atmosphere, suddenly contracts 
from the cold produced by the evaporation of the 
moisture, with which it is .ever bedewed at the time 
of birth. The consent between the skin and inter- 
costal muscles, together with that between the skin 
and diaphragm, causes their fibres to shorten — the 
ribs are now elevated, the diaphragm is drawn down 



76 A DISSERTATION ON 

towards a plane, and the thorax is enlarged. The 
weight of the atmosphere forces it into the lungs 
through the glottis to fill this newly forming cavity. 
Cold is now produced upon the surface of the lungs 
from the evaporation of the moisture upon their ex- 
terior part coming in contract with the air ; the con- 
traction of the fibre is the conseqeuence. The con- 
sent between the membrane inveloping the air cells 
of the lungs and the muscles antagonizing with the 
intercostals, causes their quick contraction, and con- 
sequently an expiration ; which is announced in the 
cries of the child. 

Thus respiration is originated, organic motion 
maintained, (d) and the exercise of the vital functions 
preserved by the actions of the atmosphere. 

The extreme sensibility of the skin makes it the 
ever vigilant sentinel to communicate alarm upon 
the attack of a foreign enemy, and thereby renders 
a service essential to the preservation of animal ex- 
istence. The skin has other and equally important 
functions to perform. It is the grand transpiratory 
organ destined to conduct off no inconsiderable pro- 
portion of the aliments and drinks received into the 
stomach. 

Sanctorius computed from actual experiment, 
that five eighths of every thingVeceived into the stom- 
ach passed off from the body through the pores of 



THE STRUCTURE OF THE SKIN. 77 

the skin ; but in this he included exhalations from the 
lungs, and consequently his calculations must have 
considerably exceeded the truth. 

The great quantity of perspirable matter continu- 
ally going off from the surface of the body, passes 
from the minute cutaneous vessels filled with red 
blood through exhalent arteries, which Ruysch and 
Albinus are said successfully to have injected. In 
the healthy condition of the animal economy, the 
quantity thrown off in a given time by cutaneous 
exhalation depends upon the compound ratio of the 
temperature of the atmosphere, its motion and dry- 
ness, upon the force of arterial action, and upon the 
quantity and quality of the diluent drinks, which 
have been taken into the stomach. Were it practi- 
cable to assume numbers representative of each of 
the above principles, the product from their entire 
involution into each other would determine the pre- 
cise quantity of matter perspired in a given time 
through the insensible pores of the skin. 

In the fourth volume of Thompson's Chemistry, 
p. 734 — 5. are detailed the experiments made by La- 
voisier and Seguin for ascertaining precisely the 
quantity of matter transpired in a given time by man. 
A bag of oiled silk was procured for this purpose, 
and it was made to inclose the whole body excepi 
the lips, for which it had a slit, and to which it was 
luted by pitch and turpentine. This bag retained 



*8 A DISSERTATION ON 

all the exhalations from the body except those 
from the lungs. From the experiments made with 
this by those gentlemen^ they draw the following 
conclusions. 

" 1. That the maximum of matter perspired in a 
" minute amounted to 26, 25 grains Troy ; the mi- 
" nimum to 9 grains Troy ; which gives 17, 63 
" grains in a minute at a medium, or 52, 89 ounces 
u in the twenty four hours. 2. The quantity per- 
" spired in a given time is increased by drink, and 
" not by solid food. 3d T Perspiration is at its mi~ 
" nimum directly after a repast. It reaches its maxi- 
" mum during digestion.'' 

This series of experiments, however ingenious, 
cannot be conclusive ; for the air contained in the 
bag after it had become partially saturated with the 
matter of perspiration, would less readily absorb the 
succeeding portions. This must necessarily dimin- 
ish the quantity thrown off by the exhalent arteries, 
for the load with which they are now oppressed from 
the bad state of the inclosed air, must check their 
actions, and their check of action cannot be imme- 
diately counteracted by a proportional reaction of 
those arteries, from which they derive their origin. 
An increased action of the secretory vessels of the 
kidneys and exhalents of the lungs is known to be 
produced by diminished perspiration, which would 
probably prevent the system from suffering during 
the time of the experiment. 



THE STRUCTURE OF THE SKIN. 7'9 

" It has been ascertained," says Mr. Thompson, 
" that water, carbon, and an oily matter are emitted ; 
"and that an acid supposed to be the phosphoric, 
" phosphate of lime, and even urea are sometimes 
" emitted through the skin." Whatever the consti- 
tuent principles of the perspirable matter may be, it 
is certain, that by long retention upon the skin or 
upon clothing and exposure to a certain temperature, 
it may undergo the putrefactive fermentation, and 
thereby become a fruitful source of disease, constitu- 
ting what Dr. Rush calls idiomiasmatic exhalations, 
the infection of typhus, camp, jail, or hospital fever. 
According to Dr. Mitchell it generates the septic 
acid, which he considered the principle of the conta- 
gion of yellow fever and of other epidemical diseases. 
But this doctrine respecting the generation of the 
septic acid by a putrefactive fermentation of the per- 
spirable matter and the alescent destroyer of its 
contagion is discarded by all the learned in the sci 
ence of chemistry. 

It is probable that this putrid miasm differs very 
little from that generated by the common putrefac- 
tion of animal substance, upon which subject M. 
Fourcroy makes the following remarks. 

f 

" Frequently the putrid masmata of the gases. 
51 which are exhaled" during the process of the pu- 
trefactive fermentation, "are so deleterious, that 
5f men and animals are deprived of sense by their 



80 A DISSERTATION ON 

" contact. When they do not produce this sudden 
" effect, they occasion putrid diseases in such as are 
" exposed to them. Some individuals contract ex- 
"ternal affections, carbuncles, malignant and gan- 
" grenous pustules by the corruptive action of these 
" vapours ; others are influenced by them in a much 
" more dangerous manner, for besides a considerable 
" prostration of the powers of life, they become af- 
" fected with putrid fevers of the most malignant 
" character. It is not yet known what is the nature 
"of the putrid gas from which these terrible effects 
" arise : it is not the azotic gas, as some modern phy- 
u sicians have thought, who on that account have 
" given it the name of sept on or rather septic gas." 

The skin performs a vicarious office with many 
other excretory organs and secerning glands, for the 
moment the skin falters in the discharge of its duty, 
the lungs and kidneys increase their secerning, 
and consequently excretory actions to relieve the 
system of the burthen, which must otherwise greatly 
oppress it ; and when the cutaneous excretions are 
copious, the urinary excretions and pulmonary exha- 
lations are proportionally small. 

The influence of temperature upon the transpira- 
tion of the perspirable matter through the pores of 
the skin will be readily understood by adverting to 
the comparative cutaneous excretions in summer 
and winter, and by comparing the reeking Ethiopian 



THE STRUCTURE OF THE SKIN. 81- 

with the panting Laplander. The vicarious func- 
tions which the skin performs in coparceny with the 
kidneys will be comprehended with equal facility by 
attending to the operation of those causes upon 
the kidneys, which obstruct cutaneous perspiration. 
The influence of the dryness and motion of the at- 
mosphere upon the quantity of vapour perspired in a 
given time, is explicable upon the principles of solu- 
tion, which must take place, that the matter of trans- 
piration and of sweat may be conducted off from the 
body. The atmosphere absorbs the vapours coming 
into contact with it the more readily, the less the 
quantity it may already hold in solution. When 
the air becomes nearly saturated with exhalations of 
any kind, man feels a langour from the inability of 
the skin to rid itself of the perspirable matter and 
caloric, which it holds in excess. This continues 
until either the state of the atmosphere is altered by 
a precipitation or dispersion of the foreign materials 
it may hold in solution, or until the reactions of the 
arteries shall have become stronger in proportion to 
the increased load accumulated upon the skin from 
the bad state of the air. The feelings of man are a 
more correct standard for determining the state of 
the atmosphere, in relation to the morbid exhalations 
with which it may be combined, than all the eudi- 
ometers and hygrometers, which have ever yet been 
invented ; and the skin is the seat in which is fixed 
this delicately constructed aero^iosometer, 

L 



82 A DISSERTATION ON 

The state of the atmosphere not only produces 
an alternation of function between the skin and kid- 
neys, but likewise between the skin and bowels, for 
a cold damp atmosphere, which shall suddenly check 
perspiration, in feeble constitutions not unfrequentljr 
brings on colliquative diarrhoea. 

The pressure of the atmosphere exerts no incon- 
siderable influence upon the skin. It is computed 
to be equal to fifteen pounds every square inch. 
Supposing the skin of a common-sized adult measure 
fifteen square feet, it must sustain a pressure equal 
to 32,400 lb. or 14 tons, 9 cwt. 1 qrs. 7 lb. gross. 
Were this pressure to be suddenly removed, while 
the pores were yet closed, man would burst like a 
cask of new wine froniifthe violent effervescence of 
its contents. The operation of cupping and experi- 
ments by the air-pump, sufficiently evince the proba- 
bility of this. 

This pressure is counterbalanced by the elasti- 
city of the internal soft parts, and that of their con- 
tained fluids. The greater this pressure the more 
vigorous the body, for increased pressure, from the 
increased weight of the atmosphere, causes a pro- 
portionally increased vigour of vibration among the 
fibres, as every one must have noticed, who has 
compared his own scale of health with the rise and 
Ml of the mercury in the barometer. This atmos- 
pherical pressure likewise contributes very much to- 



THE STRUCTURE OF THE SKIN. 83 

wards supporting the circulation of the blood in the 
veins, which, it is very well known, possess very 
little contractile power, that can render them sus- 
ceptible to action from the stimulus of the blood. 
This deficiency of contractile power in the veins, which 
is so very necessary to alternate fibrous contraction 
and elongation, is supplied by external of mospheri- 
cal pressure, and by the artificial cold produced by in- 
sensible perspiration. No fact relative to the animal 
economy is more obvious than the diminution in the 
size of the superficial veins, upon the hands and arms, 
upon exposure to a cold and clear atmosphere. 

If the contracting agency of the cold from without 
be not counteracted by the expanding agency of cal- 
oric, generated from with::, man falls palsied to the 
ground. If the caloric, which is generated by ani- 
mal action, be not conducted off by evaporation, 
man glows with fever, pants for fresh supplies of 
cool air, and supplicates for the cooling draught to 
allay the burning flames within. 

The skin, when physiologically considered as a 
whole and unique, as has already been noticed, is the 
organ, by which transpiration is carried on for the 
relief of the system, from the caloric accumulated in 
excess by the actions of the vessels. By transpira- 
tion through the insensible pores of the skin, the 
system is not only cooled down to, and maintained 
at, the standard temperature of health, but extrane. 



84 A DISSERTATION ON 

ous portions of the fluids, after the purposes of nu- 
trition and of absorption are subserved, are carried 
off from the body. The skin is the middle wall of 
partition between the internal circulating fluids and 
the external circulating atmosphere. The atmos- 
phere is the condenser, which cools down this chole- 
ric beingy man, to his rational temperature, and is 
the receiver for the free admission of all the vapours 
of transpiration, the exhalation of which is essential 
to the maintenance of the motions of life. 

The influence of the element we breathe upon 
the skin, in relation to the exercise of its healthy 
functions, has now been noticed. The discharge of 
function, founded upon arterial agency, remains yet 
to be discussed. As the exhalent arteries, whose 
office is to separate from the rest of the blood and 
conduct off the matter of transpiration and of sweat, 
are continuous from those filled with red blood, their 
actions must in a great measure be regulated by the 
actions of the heart and arteries. The force of arte- 
rial action depends upon the irritability of the com- 
ponent arterial fibres, and the strength of the stimu- 
lus applied to them. The blood, which is the natu- 
ral stimulus that makes the heart and arteries con- 
tract to originate and maintain the circulation of their 
contained fluids, is liable to variation both in quantity 
and quality ; and, of course, to variation in the force 
of the stimulus it supplies to its containing vessels 
far the continuance of its own motion. The drinks 



THE STRUCTURE OF THE SKIN. 85 

and aliments, taken into the stomach, which are the 
materials to be elaborated into blood, are capable of 
affecting the force of arterial action in two ways. 
1st. By changing the irritability of the heart and 
arteries, and 2nd. By changing the quantity or qual- 
ity of their circulating contents. 

1st. If food, unwholesome in quality, or whole- 
some in quality, but excessive or deficient in quan- 
tity, be taken into the stomach, the stomach suffers' 
a check in its healthy actions, which check of healthy 
action is propagated by sympathy to the rest of the 
system, either diminishing or increasing its irritabil- 
ity, according to the chemical nature of the aliment 
taken and the state of the organ, into which it is re- 
ceived. 

2nd. This check of healthy action in the stomach, 
from the application of a stimulus not accommodated 
to its structure and sensibility, prevents the proper 
secretions of the gastric liquor for the solution of 
the aliments taken. Imperfect chymification from 
the wrong stimulus it supplies to the contractile 
fibre of the intestines, and to that of the patulous 
mouths of the lacteals every where spread upon their 
internal surface, must necessarily produce imperfect 
chylification, and imperfect chylification, for the 
same reason, imperfect sanguification, and imperfect 
sanguification imperfect assimilation, and imperfect 
^sinuktion imperfect excretion through the insen- 



86 A BISSERTATION ON 

sible pores of the skin, along train of general as well 
as of cutaneous diseases. Here is a chain of actions 
composed of several links, mutually influencing, and 
influenced, by each other. What, from the nature 
of its stimulus, originally commenced a wrong im- 
petus upon the stomach, in consequence of the re- 
actions excited in that and its continuous organs 
concerned in performing the animal functions, passes 
from one to the other, until it arrives at the skin, 
where it expends all its remaining force. These two 
modes of attack upon the health of the skin, through 
the medium of the stomach, are exemplified in the 
sometimes sudden appearance of maculae after food, 
not accommodated to the sensibility of the organ, has 
been taken, and in the cutaneous eruptions, which 
not unfrequently appear among children from a too 
plentiful use of acid fruits. The influence of ali- 
ments upon the skin is likewise shewn in the rash, 
which almost invariably succeeds a change in diet 
from vegetable to animal food, and in a change from 
what is feebly to that w r hich is powerfully stimulat- 
ing. The reason why bad aliments should shew 
their influence in cutaneous rather than other diseases 
will be best understood by adverting to the mode 
of life, commonly pursued by those most subject to 
this kind of complaint. Unwholesome diet and drinks 
are usually taken by that class of people, who are 
as much distinguished for the filth allowed to accu- 
mulate upon their skins, as they are for their desti- 
tution of every principle of moral decorum, or their 



THE STRUCTURE OF THE SKIN. 87 

disregard of external decency. So extremely sen- 
sible is the skin, such are its exposures to the at- 
tack of morbid agents, and so invariable are its* 
sympathies with the whole body and its various 
component organs, that it becomes a matter of no 
small difficulty to determine the boundary line be- 
tween cutaneous and other diseases. The skin, 
which is the frontier of the human body, is not un- 
frequently first attacked by those morbid agents, 
which, either directly or indirectly, assail the life or 
health of man. 

Difficulties, little less perplexing, present them- 
selves in drawing a discriminating line between the 
several forms of cutaneous disease. Those authors 
who treat exclusively upon cutaneous diseases can- 
not be pursued in their arrangements. Turner is 
not sufficiently comprehensive, and Willan, whose 
depth of research and accuracy of investigation, 
whose plain distinctions and successful application 
of common simple remedies to the cure of obstinate 
diseases do honour to the medical character of the 
country which gave him birth, is too diffuse, and 
too minute in his discriminations to be followed 
in a paper like this. Nosology presents no perma- 
nent land-marks for directing our course. Like 
the titles of a knight -errant it might inspire confi- 
dence by its sound, but could never relieve in the 
hour of distress. 



&8 A DISSERTATION ON" 

Their division into contagious and non- contagious 
would be very unsatisfactory, such is the difficulty 
of determining definitively their dividing line. 
Here a wilderness presents, and the nature of the 
expedition forbids a circuitous march. 

u Nunc quoqucimq ; modo possim cognocere, dicam." 

Cutaneous diseases may be referred up to two 
causes; the one internal, the other external. 1. 
The internal cause of cutaneous diseases embraces 
all those produced by what is taken into the stomach, 
whether bad aliments or drinks, medicine or poison. 
2. The external cause of cutaneous diseases com- 
prehends all those generated by the influence of a 
bad state of the atmosphere, by contact with the 
matter of contagion or poison, whether it be animal, 
vegetable, or mineral, by change of temperature 
much above or below the standard of health, from 
communicated or abstracted caloric, and by inatten- 
tion to personal cleanliness. 

So various are these causes of cutaneous dis- 
eases in their mode of operation, so intermingled 
and obscure are they in the effects they produce, and 
such is the sameness of indication, whether they are 
individual, compound, or collective in their opera- 
tion, that they can furnish little or no assistance in 
framing divisional lines between the several par^s of 
the pathology of our subject. The sameness of ef- 
fect from the action of these multifarious causes will 



THE STRUCTURE OF THE SKIN. 89 

be readily acceded to. on considering that their ope- 
ration is more or less dangerous according to the 
degree and suddenness of check they produce in the 
function of perspiration. As the restoration of this 
function to the skin should be the ultimate object to be 
accomplished, and as this cannot be effected where 
the parts upon whose actions its exercise depends 
have been deranged in structure before their healthy 
re -organization, we shall be justified in dividing cu- 
taneous diseases into the two following classes. 1st. 
The first class comprises all those necessarily attend- 
ed by derangement in the structure of the skin, or the 
destruction of one or more of its strata. 2nd. The 
second plass comprises all those necessarily attended 
by derangement in function only ■. 

Though derangement in structure may likewise 
attend the second class, still it is only an occasional 
circumstance, and by no means necessary to its pro- 
duction. 

1st. That class of cutaneous diseases attended 
by derangement in the structure of the skin or by 
the destruction of one or more of its strata, admits 
of subdivision into two orders. 1. When they are 
accompanied by an excess of arterial action, and 2. 
When they are accompanied by a deficiency of arte- 
rial action. Although this distinction between the 
two first orders of our subject is apparently founded 

in the human constitution, still as the system is Ha- 

M 



90 A DISSERTATION ON 

ble to such sudden and frequent transitions from the 
one state of arterial excitement to the other, the orders 
must be necessarily neglected in pursuing our in- 
quiries into their phenomena and cure. 

The nature of both these states of this class of 
cutaneous diseases points out the same indication of 
cure, viz. the restoration of the vessels leading to 
and from the skin to that standard of action favoura- 
ble to the reproduction of destroyed parts, or to the 
removal of morbid changes in structure. In the re- 
generation of parts, which have been once destroyed, 
nature seems to imitate the process, originally pur- 
sued in the formation of the foetus in utero. ( Coag- 
ulable lymph is granted by all modern physiologists to 
be the material for fabricating new parts. Its read- 
iness to separate from the other component parts of 
the blood Mr. Hewson proves to depend upon the 
quantum of arterial action. There is a certain me- 
dium state of vascular action, which is peculiarly 
suited to the regeneration of lost parts. It is what 
Mr. John Hunter calls the adhesive stage of inflanv 
mation. In this stage of inflammation, coagulable 
lymph, of proper quality and in proper quantity, is 
eifused from the patulous mouths of the minute ves- 
sels for the renovation of destroyed organic fibre* 
The pus found upon the healing surface of a healthy 
granulating sore answers as nearly to the waters in- 
closed in the membranes, which surround the foe- 
tus in utero y as the circumstances attending the two 



THE STRUCTURE OF THE SKIN. 91 

states of existence in relation to the different suscep- 
tibilities and exposures to the action of different sti- 
muli will admit. It is one of the first maxims in 
the practice of surgery never, to disturb the process 
^of nature in her actions for the renovation of destroy- 
ed parts, whether superficial or deep-seated ; but to 
remove every irritating cause by frequent ablution 
with soap and water, and the application of such soft 
dressings as absorb the pus as it is secreted, and 
prevent every kind of mechanical or chemical irrita- 
tion : likewise in the cure of cutaneous diseases at- 
tended with death in one or more of the strata of 
the skin, perfect cleanliness by a free use of water 
accommodated in its temperature to the state of the 
system, and the removal of every kind of irritation, 
are essentially requisite. In the cure of sores, the 
accommodation of the aliments and drinks, both in 
quality and quantity to the irritable fibre of the sto- 
mach and bowels is deemed of the first importance ; 
likewise in the cure of cutaneous diseases, where a 
part, that has been destroyed, is to be regenerated, 
great attention must be paid to accommodating the 
food to the powers of the digestive organs. In the 
healing of an ulcer, the temperature of the part af- 
fected, and the action of the arterial system are con- 
sidered objects demanding vigilant attention ; also in 
the regeneration of dead portions of skin and in ob- 
viating morbid changes in structure, the temperature 
of the skin and the action of the arterial system must 
be regulated by the most watchful observation. If 



92 A DISSERTATION ON 

the heat be too great, cooling applications should be 
made to the seat of the disease, as cool air, cold wa- 
ter, lead water, &c. and if the arteries in their actions 
transcend the adhesive stage of inflammation, the 
force of the circulation should be diminished either 
by blood-letting, or by some other depletion accord- 
ing to the state of the system. If the arterial action 
fall below the inflammatory state, usually denomi- 
nated the adhesive, bark, wine and nutritious diet 
should be given to raise it up to that state. All lo- 
cal applications should be accommodated as nearly 
as possible to the sensibility of the part. If from 
atony the secretory ducts called the exhalent arteries 
become too much dilated in their diameters, astrin- 
gents should be applied to make them contract and 
recover their accustomed tone. If the skin have 
suffered a great accumulation of morbid sensibility 
some preparation of opium should be blended with 
the lotion to remove the morbid sensibility of the fi- 
bre, and prevent inflammation from the action of the 
other ingredients dissolved in the lotion. The sti- 
muli to be applied to the skin in the cure of cuta- 
neous diseases, as well as those to be taken internal- 
ly, must exceed in force the irritation constituting it, 
or the cure is incomplete. As in the motion of in- 
animate matter when two bodies meet from coun- 
ter directions, the one which has the greatest mo- 
mentum, stops, or changes the motion of the one 
possessing the least, so when two impressions are 
made upon the same part of an animal at the same 



THE STRUCTURE OF THE SKIN. 9,3 

time, the greater always destroys the less. This 
doctrine admits of extensive application to the cure 
of certain obstinate cutaneous diseases. 

The force of the medicine should not only ex- 
ceed the force of the irritating cause, which had 
produced the disease, but its exhibition should be con- 
tinued, until the morbid habit of action, constituting 
the inveteracy of the disease, be completely destroyed. 

E. F. a maiden lady between fifty and sixty- 
years of age, of spare habit, was attacked over her 
whole body with scaly incrustations, attended with 
the effusion of a bloody ichor upon their abrasion. 
The skin exhibited as much the appearance of the 
leprosies of authors as almost any complaints which 
occur in this country. Ethiops mineral and anti- 
mony, combined with acid preparations of mercury, 
were first administered without success. Native 
oxide of arsenic, the arsenious acid of the chemists, 
was next resorted to, and taken in the dose of one 
twelfth of a grain once in one or more days accord- 
ing to the effects produced, and continued for three 
weeks, additional tcra low diet and abstinence from 
animal food, cured the patient. Bark, wine, and a 
nutritious diet, after the disappearance of the disease, 
soon elevated the system to the standard of health. 

If the remedy be not accommodated in its force 
to the force of the disease, it may induce a new 



94 A DISSERTATION ON 

disease more malignant than the original one ; or, 
in conformity to common language, aggravate the 
original disease. 

S. A. a middle aged labouring man, of temper- 
ate habits and robust constitution, in the former part 
of the Spring of 1806, was affected with a trouble* 
some eruption upon his legs and feet, arms and 
hands, which was accompanied with a constant ooz- 
ing of a corrosive humour. Its cause could not be 
detected in diet, exercise, or in any previous expo- 
sure to cold. A wash of corrosive sublimate was 
first applied, but without affording him any relief : 
rigid injunctions were likewise made respecting his 
diet and the maintenance of his body at an equable 
temperature. Arsenic was afterwards administered 
internally, but its operation rather aggravated the 
complaint, after it had been taken between two and 
three weeks. The following remedies were at last 
administered which effected the cure. 
R. Marine acid gt. x 

Muriate of mercury grs. x 

Antimonial wine § i. 
M. 

The patient began the use of this remedy by tak- 
ing fifteen drops twice a day, which were gradual- 
ly increased to twenty-five. The following wash 
was at the same time, externally applied to the seat 
of the disease. 



THE STRUCTURE OF THE SKIN, 95 

R. Muriate of mercury grs. xxx. 
Spirits of wine, B viii. 

M. 
These articles were mixed with tar- water, and used 
twice a day. The above remedies, both the inter- 
nal and external, were used between two and three 
weeks before an entire cure was effected. The pa- 
tient fed on a milk diet twice a day, and sparingly 
upon animal food once a day during the exhibition 
of the above medicines. 

The introduction of laws respecting personal 
cleanliness into the religious rites of those nations, 
who inhabit those warm climates, where obstinate 
cutaneous diseases most abound, shows that the 
common sense and common experience of mankind 
in those places have decided, that the cleanliness of 
the skin is the surest preventive and most certain 
cure of its diseases. The Hindoo (e) cleans his 
skin in the Ganges under a pious delusion, that he 
is washing away his sins. Wash and be clean was 
the divine prescription to the ancient Jewish leper 
upon his release from confinement and readmission 
to the enjoyment of the rights of social intercourse 
with his brethren. * 

(f) A rising, a scab, and a bright spot, were the 
diagnosticks pointed out for the Jewish doctors to 
notice in their discriminations of the plague of lepro- 
sy from other diseases. The leprosies of Britain, 



96 A DISSERTATION ON 

which Turner acknowledges he could not cure either 
by mercury or the mineral waters, Willan observes, 
are generally cured by a free use of warm bath, cold 
bath, (g) sea-bathing, gentle friction, and proper at- 
tention to diet and temperature. Cleanliness, the 
use of alkali as subservient to this, and friction , 
seem to have been known to the Arabs as remedies 
in the cure of cutaneous diseases in the days of Job. 
And he took him a pot -sherd to scrape himself withal, 
and he sat down among the ashes* In the Philadel- 
phia Medical Museum mention is made of the Afri- 
can remedy used in the cure of yaws, framboesia. 
The patient is immersed in a stream of running wa- 
ter, in which he remains, until his whole skin has 
been faithfully and severely rubbed, (h) Willan 
lays great stress upon the use of warm bath and cold 
bath, and upon sea-bathing in the cure of a majority 
of his cutaneous diseases. Much attention is neces- 
sarily paid to the state of the stomach and bowels, to 
the force of arterial action, to the temperature of the 
body, (i) and to cleanliness, as has already been re- 
marked, in the cure of all forms of cutaneous disease, 
whether originating from an internal or an external 
cause, independently of the local applications, which 
are to be made to the seat of the complaint. 

The local applications to be made to the skin in 
the cure of this class of cutaneous diseases, are de- 
signed either to diminish the temperature of the skin, 
of to remove every cause of irritation from its naked 



THE STRUCTURE OF THE SKIN. 97 

fibre, or to produce some change of action in the mi- 
nute cutaneous vessels. 

Cool air, cold water, and the various solutions 
of muriate of ammonia and of acetite of lead, fulfil 
the first indication. 

Frequent ablution with tepid water, with alkaline 
water, the application of dry lint and of other ab- 
sorbent articles to receive the ichor or matter, as 
they are thrown out, and the various bland unguents, 
used merely to guard the skin against the contact 
of the atmosphere, fulfil the second indication. 

The various astringent and stimulating lotions 
and ointments fulfil the third indication. 

All the external applications, necessary in the 
cure of the greater part of the cutaneous diseases, 
which occur in New- England, are comprised in the 
remedies which fulfil the two first indications. The 
third indication may sometimes require attention in 
the cure of some species of the herpes or cutaneous 
ulcer of Mr. Bell. 

Muriate of mercury, sulphate of zinc, and ace- 
tite of lead are among the best solvends to enter into 
the composition of the various washes to be external- 
ly applied for changing the action of the minilte 
cutaneous vessels, and thereby giving the ulcer the 
disposition to heal. 

N 



9S A DISSERTATION ON" 

Tetter, ring-worm, and shingles, according to 
Mr. Bell, express the different species of herpes as 
they occur in England. Tetter in its milder form 
is attended by an itching upon the skin and desqua- 
mation of the cuticle. In its severe forms, it is ac- 
companied by not only an abrasion of the cuticle 
but by scaly incrustations of the lymph and serum 
which are effused. Its most obstinate form Mr. 
Bell calls herpes exedens, or phagadenic ulcer. 

Lead water combined with laudanum, and satur- 
nine ointment medicated with an opiate preparation 
are valuable external applications in the cure of some 
species of tetter. They, at the same time, allay the 
heat, and diminish excessive sensibility. 

Mrs. D — , of robust constitution, but addicted 
to the intemperate use of ardent spirits, between sixty 
and seventy years of age, was seized with many fe- 
brile symptoms, as loss of appetite, furred tongue, 
increased sensibility, and heat upon the skin, which 
were accompanied with a troublesome itching. 
Her illness commenced some time in the month of 
September, 1807. Pil. coc. and submuriate of mer- 
cury were first administered with a view to a 
thorough evacuation of her bowels. She was direct- 
ed to apply lead- water mixed with laudanum to the 
parts most violently affected. She took a pill of 
calomel and opium at night. These remedies pro- 
duced a temporary remission in the violence of the 



THE STRUCTURE OF THE SKIN. 99 

symptoms, when they were first used, but soon lost 
their influence. Costiveness returning, she was di- 
rected to take a cathartic pill every other day to reg- 
ulate the peristaltic motion of her bowels. The 
eruption at first was of the pustular kind. The 
pustule had an inflamed base, and rose up in a 
manner giving it the resemblance of the half of a 
common- sized field-pea. The eruption at length 
extended over the whole surface of her body* There 
was an exacerbation of all her painful symptoms, 
when day-light first appeared. She would then call 
upon her nurse to hunt up all the pustules upon her 
body for the purpose of their being pricked with 
a needle. They discharged a watery humour rath- 
er corrosive than otherwise. The water appeared to 
be deeper seated, than that contained in common 
vesicles, situated between the cutis vera and scarf- 
skin. At length the pustules increased in size about 
their bases, and apparently run into one another, 
making the skin exhibit the appearance of a uni- 
form scab. These appearances took place between 
two and three weeks after her first attack. She 
was now ordered to use warm bath ; and the first 
night after its use all her symptoms seemed to be 
rather mitigated in their violence. The saturnine 
lotion had been previously laid aside for the satur- 
nine ointment, which was likewise medicated with 
an opiate. Under the influence of these various 
remedies, the skin at one time seemed to have been 
very nearly healed ; but the disease again returned 



\ 



100 A DISSERTATION ON 

with renewed violence. Previously to every re- 
application of the saturnine ointment, the parts 
were washed over with soap and water. 

Her constitutional strength had now so much 
declined, that bark and wine were necessarily pre- 
scribed to maintain the proper excitement of the 
system. The old lady growing rather impatient un- 
der her increasing infirmities, and desirous of trying 
some new remedy, frequently solicited the trial of 
Glauber's salts instead of her usual cathartic pill. 
She was indulged ; but reaped not the expected ad- 
vantage from the operation of her favourite remedy. 
The unguentum acetitis plumbi was now laid aside, 
and the tar ointment substituted. In the course of 
a week the symptoms seemed somewhat to abate | 
but they disappeared only to return. 

She was again ordered the use of warm bath, 
which was attended in its operation with many good 
effects. The tar ointment was in turn laid aside, 
and a sulphur unguent used in its stead. This 
seemed to be attended with more decidedly good ef- 
fects, than any external application, which had pre- 
viously been made, warm bath excepted. Her 
stomach all this while performed its offices tolerably 
welh The powers of her constitution were support- 
ed by a generous diet upon animal food, by wine, 
bark, and, towards the latter stage of her disorder, 
she was indulged in the moderate use of brandy. 



/ 



THE STRUCTURE OF THE SKIN. 101 

The progress which her eruptions took, was 
from the head downward. Her legs and feet were 
the last that healed perfectly. The itching, heat, 
and restlessness kept her in constant torture. The 
interval between the first appearance of the disease 
and its final cure somewhat exceeded two months. 
Her sensations were most distressing, while the pus- 
tules were pushing out in the palms of her hands and 
upon the bottoms of her feet. 

Sulphur furnishes a stimulus, which is peculiar- 
ly suited to the cure of many cutaneous diseases. 
Mr. B. Bell * has prescribed a lotion made by put- 
ting together lead water, rose water, and lac sulphu- 
ris, with very great success in the cure of certain 
species of tetter. 

Tinea capitis, which Syndenham very appropri- 
ately denominates scab of the head, and which Mr. 
Bell places in the species of herpes, which he terms 
pustulosus is readily cured by shaving off the hair 
and applying the tar ointment. In the London 
Medical and Physical Journal, No. 14, p. 496, is a 
formula for a remeay, said to be very efficacious in 
the cure of tinea capitis. 

R. Kali Sulphurat. (recens preparat) 3iij\ 
Sap. Alb. Hisp. 3iss. 

* On Ulcers, p. 200. 



102 A DISSERTATION ON" 

Aq. calcis. Sviiss. 

Spts. vin. rectf. $ij. 

m. f. lotion for washing the head morning and even- 
ing, suffering it to dry spontaneously. Previous 
shaving the head is unnecessary, when this remedy 
is used. In one case which came within the circle 
of my observation, the vaccine innoculation nearly 
cured the patient of a very violent scab of the head 
The fact is noticed by the writers upon the Cow- 
Pock. 

Shingles which is a troublesome eruption ap- 
pearing upon the lower part of the body, sometimes 
encompassing it, are very easily cured by attending 
to the general remedies previously laid down. 

Ring -worm is ordinarily very readily cured by 
the sulphur ointment, by mercurial unguents or lo- 
tions, &c. 

Trichoma, or plica Polonica, furnishes an exam- 
ple of diseased structure in the hairy scalp. It is an 
endemic disease, peculiar to Poland, and the neigh- 
bouring countries. The causes, which produce it, 
have not yet been satisfactorily investigated. The 
disease is said to be both contagious and congenital. 
A detailed account of it is to be found in the first 
volume of Duncan's Annals of Medicine, to which 
the reader is referred for satisfactory information 



THE STRUCTURE OF THE SKIN. 103 

respecting it : the rarity of the disease renders its 
discussion unnecessary in this place. 

Elephantiasis presents the most horrid example 
of diseased structure of the skin of which the imagi- 
nation of man can conceive. In Barbadoes, it is cal- 
led the glandular disease from the circumstance of its 
exhibiting its first symptoms in an inflammation of 
the inguinal glands. It remains a question whether 
the disease admit of cure. The, powers of the con- 
stitution by the aid of the most active articles in the 
materia medica have not hitherto been adequate to it. 
Although the disease does not occur in the United 
States, still as the history of its causes, progress, and 
termination evinces that its treatment, to be success- 
ful, involves a knowledge of principles of the ani- 
mal economy r , which have not been satisfactorily ex- 
plained, I have transcribed, in the Appendix, the ac- 
count of it given by Pinkerton in his notes on the 
West Indies.(j) It seems not improbable, that the 
disease originates in obstructions, which prevent the 
flow of lymph to the thoracic duct. This, it is nat- 
ural to suppose, would cause an effusion of lymph 
through its delicately constructed vessels, which 
would probably coagulate, and thicken the skin. 
The pathology of he lymphatic glands and vessels, 
and the remedies, which from their accommodation 
to their structure and sensibility are adapted to the 
cure of their diseases, are yet involved in much ob- 
scurity. Even a wounded lymphatic of any consid- 



104 A DISSERTATION* ON 

erable size has hitherto baffled all the skill of the 
f acuity. [k) 

Warts and corns, verruca andclavi, belong to the 
class of cutaneous diseases attended by derangement 
in the structure of the skin. The former are cured 
by compression, by excision, and by cauteries, both 
actual and potential; the latter by excision and the 
subsequent application of an emollient oil for pre- 
serving a softness upon the part. 

Scurvy, though a general disease, commonly 
makes its first appearance upon the skin, probably 
from the circumstance of its very delicate structure. 
Proceeding from an internal cause, i. e. from un- 
wholesome diet or drinks, a general laxity of fibre 
takes place, which is to be strung up by a nourishing 
diet upon ascescent vegetable food^by astringent and 
tonic barks, by the mineral acids, by decoction of the 
root of the water-dock, spruce beer, Sec. 

II. The second class of diseases, usually denomi- 
nated cutaneous, embraces all those necessarily attend- 
ed by derangement in thefu?tctio?ts of the skin simply. 
Here three questions naturally arise. 1st. What 
are the functions of the skin? %nd. How are these 
functions deranged ? and 3d. By what remedies is 
this derangement in the functions of the skin to be 
obviated. 



THE STRUCTURE OF THE SKIN. 105 

1st. What are the functions of the skin? It has 
already been noticed, that the regulation of animal 
temperature is one of the most important functions 
of the skin. Animal temperature is prevented from 
transcending the standard temperature of health by 
spontaneous evaporation, or the insensible transpira- 
tion of the perspirable matter through the pores of 
the skin, 

Another obviously important function of the skin 
is its being the seat of the sense of touch. 

The health of the system, as connected with 
cutaneous absorption, must necessarily be passed by, 
so very little is known of the cutaneous absorbents. 

2nd. How are these functions deranged ? The 
functions of the living healthy skin become deranged 
in their exercise by all those agents, which either in- 
crease the actions of the skin above the standard ac- 
tion of health, or reduce them below such standard . 
If poison, contagion, or any miasm come in contact 
with the denuded fibre of the true skin, the fibre 
touched is checked in its actions, and a general con- 
traction of the organ takes place. Perspiration be- 
comes obstructed, and increased arterial action is ex- 
cited to remove the obstructing cause. 



When the powers of animation become nearly 

exhausted, perspiration is manv times exceedingly 

O 



106 A DISSERTATION ON 

profuse, which profuse perspiration often terminates 
in the cold sweat of death. 

Increased or diminished sensibility of the skin is 
likewise accompanied with an increase or diminu- 
I tion in the force of arterial action; 

3d* By what remedies is this derangement in 
the functions of the skin to be obviated* 

Increased sensibility of the organ is to be obvi- 
ated by the subtraction of all irritants from it, while 
the necessary remedies are administered for regu- 
lating the general health of the system. Diminished 
sensibility is to be cured by friction, by Warmth ex- 
ternally communicated, and by sundry irritating ex- 
ternal applications as cantharides, &c. 

In treating upon derangement in the function of 
perspiration, the class of remedies, which the writers 
upon the materia medica call sudorifics y is necessarily 
discussed. 

In the healthy animal economy, the quantity pers- 
pired in a given time is regulated by the quantity of 
diluent drinks taken into the stomach, by the force of 
arterial action, and by the state of the atmosphere, 
which is to absorb whatever is transpired through 
the insensible pores of the skin. Variations in 
either of these produce corresponding variations in 



THE STRUCTURE OF THE SKIN. 107 

the exercise of- the function. of perspiration. Va- 
riations in the non-conducting substances externally 
applied, usually denominated clothing, likewise pro- 
duce variations in the quantity perspired in a given 
time. There is a certain degree in the scale of ani- 
mal temperature, which may be called the perspira- 
ble point. If the actions of the system concerned 
in the generation of animal heat transcend this point, 
perspiration is obstructed. That this is the fact ev- 
ery one must have noticed in his daily attentions to 
the maintenance of the temperature of his body at 
the pleasurable degree. Too much clothing pro- 
duces a febrile diathesis by diminishing perspiration. 
Upon laying aside the superfluous part of the clothing, 
the atmosphere receives and carries off from the 
body the matter of transpiration and of sweat, and 
thereby produces a refreshing coolness, which suc- 
ceeds to the febrile diathesis, the surface being now 
slightly moistened. These phenomena are readily 
witnessed during the hours of repose. Throwing 
off a portion of the bed-clothes, when there is a fi- 
brile diathesis, invariably produces the desired relief 
by restoring to the skin the function of perspiration, 
especially if the general health have not been pre- 
viously impaired. On the other hand, when animal 
temperature is much reduced below the perspirable 
point, an increase of clothing by causing animal 
heat to accumulate, until it shall have attained that 
point, restores to the skin the exercise of this func- 
tion, particularly when its derangement is slight, and 
is not associated with anv general disease. 



10S A DISSERTATION Ofr 

Diluent drinks exert a very evident influence 
upon the skin in maintaining the exercise of the func- 
tion of perspiration. The temperature as well as the 
quantity and quality of these diluent drinks should 
be cautiously accommodated to the state of the system. 
Cold water, which readily excites perspiration or 
sweating when the system is elevated in temperature 
above the perspirable point, would check it, when 
the system is reduced in its excitement below that 
point. Blood letting and active cathartics in a sys- 
tem too much excited would do much towards ob- 
viating derangement in the important function of 
perspiration; but to a system already below the 
standard excitement of health they would prove ex- 
tremely injurious in relation to perspiration. The 
stimulating diaphoretics, which are very efficacious 
in promoting the healthy exercise of this function in 
cases of obstructed perspiration attended with feeble 
arterial excitement, in cases of obstructed perspira 
tion attended with increased arterial excitement, 
would defeat the very purpose, for which they had 
been administered. When the stimulating diaphor- 
etics taken internally operate powerfully upon the 
kidneys, very much increasing the flow of urine, 
they make little or no impression upon the minute 
exhalent vessels of the skin ; and, when they promote 
copious mucous discharges from the bowels, they 
are equally inoperative upon the skin. When all 
the internal remedies prove ineffectual from the cir- 
cumstances above related, the wished-for diaphore- 



THE STRUCTURE OF THE SKIN. 109 

sis may sometimes be produced by the external ap- 
plication of steam. Dr. Alexander, after an attempt 
to provoke sweating by a free use of warm and af- 
terwards of cold drinks, which were ineffectual, be- 
cause they produced diuresis, obtained his desired 
object at last by the application of flannels wrung 
out of boiling water to his legs and thighs.* 

Those medicines endued with strong emetic pow- 
ers produce a very evident operation upon the skin* 
The different preparations of mercury and of opium 
likewise act powerfully upon it : these several medi- 
cines combined produce a very evident operation 
upon the function of perspiration. Upon the au- 
thority of a learned medical professor f the assertion 
rests, that James' Powder is one of the most certain 
diaphoretics in the incipient stage of fever. Mr. 
Davy in his analysis of this powder has shewn it to 
be a calcareous phosphate of antimony. Long- con- 
tinued sweating produces great prostration of 
strength, unless it be supported by the plentiful use 
of cordial diluent drinks. 

The application of each of the diaphoretic reme- 
dies, above alluded to, to the cure of all diseases, 
where derangement in the exercise of the function 



* Experimental Essays, p. 180. 
f B. S. Barton, M. D. Professor of Materia Medica at Philadelphia. 



110 A DISSERTATION ON 

of perspiration is a prominent symptom, would 
lead beyond the original limits, assigned to the dis- 
cussion of the subject. It may, however, be prop- 
er to remark, that the diaphoretic medicines should 
be so regulated in their use, as never to excite co- 
pious sweating, but only to raise a moisture upon 
the skin, which generally should be kept uniform 
for a considerable length of time ; otherwise the 
function of perspiration would be but partially res- 
tored to the skin. 

The general principles regulating the exercise of 
the function of perspiration having been discussed, 
this class of cutaneous diseases requires a subdivi- 
sion into two orders. 1st. When they are attended 
by too much, and, 2nd. When they are attended by 
too little arterial excitement. 

1st. The first order embraces most of the exan- 
themata of authors in their usual phenomena, as va- 
riola or small pox, variclla or chicken pox, cow- 
pock, erysipelas as it appeared in the days of Sy- 
denham, rubeola or measles, milliaria or miliary 
fever, &x. The propagation, progress, and termi- 
nation of these fevers prove them to be cutaneous 
diseases. 

The matter of contagion of the contagious por- 
tion of this class of cutaneous diseases, upon com- 
ing in contact with the naked fibre of the skin, pro- 



THE STRUCTURE OF THE SKIN. Ill 

duces a check of action in the fibre, or, in other 
words, a spasm, and this check of action or spasm 
gradually extends until the whole skin is drawn into 
a state of contraction. Perspiration is diminished, 
and heat consequently accumulates. The cutane- 
ous arteries from their increased fulness and tem- 
perature increase their actions. This arterial reac- 
tion extends, until the whole arterial system and 
heart are made to co-operate in their efforts to force 
open the cutaneous exhalents, or overcome the 
spasm upon the skin. After this is effected, the 
heart and arteries return to their healthy standard oi 
action, when nature discharges her patient cured. 
But this reaction is often so violent from increased 
irritability and additional force of stimuli, that the 
minute vessels become deranged in structure beyond 
the power of recovery, when the body passes sudden- 
ly from life to the putrefactive fermentation. Sea- 
sonable attention to the reactions of the system by 
maintaining the proper balance between " the excit- 
ing powers and excitabilty," may almost invariably 
prevent this rapid dissolution. Certain eruptive 
fevers of this order must run a certain determinate 
course, before the skin can possibly be made to re- 
sume the exercise of its usual healthy functions. 

The object of the practitioner in such cases must 
be the prevention of those consequences to the sys- 
tem, which necessarily result from obstructed per- 
spiration by artificial substitutes for conducting off 



112 A DISSERTATION ON 

the heat from the body, by diminishing the exces- 
sive actions of the vessels, which generate it, and 
by increasing the actidhs of those parts, which alter- 
nate in their functions with the skin. Cool air, cold 
water, &x. are the best artificial substitutes for per- 
spiration in the reduction of excessive temperature. 
Rest, abstinence, and blood-letting are the most cer- 
tain remedies for the reduction of excessive arterial 
action. Emetics and cathartics, diuretics and dilu- 
ents, increase with most certainty the actions of 
those parts, which alternate in their functions with 
the skin. The limits of a dissertation must form our 
apology for not discussing each of the above erup- 
tive fevers in detail. 

2nd. The second order of this class of cutaneous 
diseases comprises those attended with too little arte- 
rial excitement. The general remedies to be employ-* 
in the cure of this order of cutaneous diseases, are 
tonics, generous diet upon easily-digested animal 
food, friction, exercise, cold-bath, warm-bath, sea- 
bathing, wine, alcohol, and stimulants for external ap- 
plication. Much caution should be used in maintain- 
ing the body at the standard temperature of health by 
warm clothing, and avoiding all sudden transitions 
from a heated to a cold atmosphere. 

All the eruptive fevers, which have been noticed 
in the first order of this class of cutaneous diseases, 
are liable to degenerate into the second order of the 



THE STRUCTURE OF THE SKIN. 1X3 

same class. When this synocha state of fever, which 
ordinarily accompanies the exanthemata, degenerates 
into typhus, the most approved remedies employ - 
ed in the cure of typhus must be used, as emetics, 
calomel and opium, wine and bark, rubefacients and 
blisters, acid diluent drinks, frequent ablution of the 
skin with water accommodated in its temperature to 
the state of the system, &x. Erysipelas, as it com- 
monly appears in the climate of New- England, as- 
sumes the type of typhus. Erysipelas, although not 
unfrequently attended by an abrasion of the cuticle 
and an effusion of a corrosive ichor, still as the disease 
may, and often does, exist without either of these, 
should be retained in this order of the second class of 
cutaneous diseases, which are necessarily attended 
by derangement in the functions of the skin simply. 

One of the most valuable external applications I 
have ever used in the cure of erysipelas is wheat flour. 
This, at the same time it very gradually conducts off 
the heat from the part affected, absorbs the ichor as 
it is effused, and thereby preserves the surrounding 
parts from excoriation. The flour should be re- 
peatedly applied, until the temperature of the part is 
reduced to the healthy degree. 

Blisters applied to the seat of the inflammation are 
often attended with advantage. Much attention 
should be paid to the internal exhibition of stimu- 
lants, of tonics, of cooling diluent drinks, &c. 

P 



114 A DISSERTATION ON 

Itch is a contagious disease sui generis, which 
commences its attack upon those parts of the skin 
most exposed to the action of the matter of retained 
perspiration. The eruption appears first between 
the fingers, upon the arm-pits, in the hams, &c. 
When allowed to run on for a length of time, the 
eruption extends over the skin of the whole body. 
A small insect which insinuates itself into the skin, 
is sometimes the cause of the disease. It is called 
the Acarus Siro fexulcerans of LinnausJ by Dr. 
Adams, to whose treatise on Morbid Poisons, the 
reader is referred for its particular history. 

An ointment of three parts of lard to one of tar, 
saturated with sulphur, by melting the ingredients 
together, is an application peculiarly suited to the 
cure of itch. The several mercurial washes and 
unguents are likewise effectual remedies, but are at- 
tended with more hazard to the general health of the 
patient in their operation, than the above sulphur 
ointment. The flowers of sulphur are said by Mr, 
Bell not to be so efficacious as crude brimstone, al- 
though Boerhaave* says, that sublimation produces 
not the least alteration in the i properties of sulphur. 
The most common remedy in the cure of itch 
among the people in the interior is made by blend- 
ing the bruised root of yellow-dock with cream. 

* Boerhaaves's Chemistry, Vol. 2d. p. 265. 



THE STRUCTURE OF THE SKIN. 115 

The violent itching, produced by pediculi pubis, 
pediculi corporis, or pedicali capitis, is cured by kill- 
ing the vermin, whose bite caused and continues the 
irritation. Soap and water, alkaline water, the sev- 
eral mercurial washes and unguents, and a great 
variety of other applications to the seat of the irrita- 
tion at once remove the complaint. 

Petechia often appear upon the skin in the 
iatter stages of typhus fever, but the)' are the result 
of general debility, and are to be cured by those rem- 
edies, that have been already enumerated, which re- 
move this debility. Tincture of cantharides exter- 
nally applied, additional to friction, commonly an- 
swers a very good purpose. 

Petechia are likewise produced upon the skin by 
a diet, which is not accommodated to the sensibility 
of the stomach. In such cases emetics and cathar- 
tics afford the most speedy relief, (l) 

The poisons, afforded by the three kingdoms of 
nature, when externally applied to the skin, produce 
a .great variety of cutaneous eruptions. Washing 
the part, coming in contact with the matter of the 
poison, with soap and water, alkaline water, or with 
almost any caustic solution, directly after the expo- 
sure of the skin to the action of the poison, either pre- 
vents or cures the cutaneous diseases, already gener- 
ated, or to be generated, by the action of the poison, 



116 A DISSERTATION ON 

A physician of high respectability related to me a case, 
where the patient, a robust sailor, was bitten upon 
the linger by a rattle-snake, Violent symptoms, 
which threatened his immediate destruction, super- 
vened. Destruction of the part bitten by sulphuric 
acid arrested the further progress of the disease and 
eventually effected a cure. 

A question here very naturally occurs ; viz. what 
cutaneous eruptions is it unsafe to cure, and why 
is their cure attended with hazard ? 

In certain diseases attended with great debility, 
local irritations upon the skin by caustic, setons, 
cantharides, &x. are excited to provoke the system to 
a more vigorous action. This is only imitative of 
a process, sometimes pursued by nature for relief 
in certain cases of great distress. Cutaneous erup- 
tions of long standing are accompanied with an ir- 
ritation, which from the influence of habit, has become 
a necessary stimulus in maintaining that degree of 
action which constitutes health. If this irritation be 
suddenly removed by the cure of the eruption, the 
patient falters like the palsied dram-drinker before 
he has taken his morning sling. This local irritation 
may however be removed with safety, if some cor- 
responding irritation be excited upon the bowels by 
the occasional use of stimulating cathartics. Sud- 
den transition from violent to feeble action produces 
as much derangement in the health of animals, as 



THE STRUCTURE OF THE SKIN. 117 

would an accelerated march of the sun from Cancer 
to Capricorn in the health of plants. Remove from 
the Turk his opium and he languishes. Wine recov- 
ers him. After using the wine awhile, he feels suffi- 
cient vigour without either wine or opium. The 
following fact I have from a respectable source. 

The late Dr. Fay, while a resident practitioner 
at Boston, was called to two African children, who 
were covered over their whole bodies with body-lice. 
He ordered them to be immediately washed all over 
with warm soap-suds, with a view to the destruction 
of the vermin. The sudden removal of the irritation 
by the sudden destruction of the vermin, additional 
to the warmth of the water, suddenly checked the 
motions of life, and the children dropped down, and 
expired immediately. 



A 

DISSERTATION 



ON 



THE CAUSES, DIAGNOSTICKS, AND CURE OF BILIARY 
CONCRETIONS. 

All stimuli taken into the stomach, act pri- 
marily upon that organ, from which their influence 
is propagated to every portion of the system. 

Those parts are most affected, which possess' most 
irritability, associated with the least muscular con- 
tractility, and are situated nearest to that organ to 
be most influenced by what medical writers call con- 
tiguous sympathy. The liver is an organ, in which 
modern anatomists cannot detect a single muscular 
fibre ; of course it can possess little contractility, or 
power of recovery, after its fibre has been once 
stretched beyond its mean state of action. Drunk- 
ards are observed to have disordered livers soon af- 
ter the quantities of liquid fire, of which they are 
in the daily use, have impaired the tone of the sto- 
mach by over- stretching its fibres in their actions. (m) 
But other causes than dram- drinking contribute tO- 
wards producing derangement in the functions of 
that important viscus. As deficient secretion or 



120 A DISSERTATION ON 

excretion of bile brings on dyspepsia, so dyspepsia, 
from whatever cause originating, checks the liver in 
the performance of its functions, and renders defi- 
cient the secretion or excretion of bile. 

The frequency of liver- complaints in low lati- 
tudes arises from the combined agency of a heated 
moist atmosphere, and certain destructive modes of 
diet and still pore destructive habits of life upon 
the human constitution, particularly upon the stom- 
ach and alimentary canal. The liver, possessing 
comparatively little vital power, suffers most from the 
general attack of these agents. 

The blood, which circulates to the liver to sup- 
ply it with the materials for biliary secretion, comes 
principally from the chylo-poietic viscera. Addi- 
tional to the contractions of the mesenteric arteries 
from the stimulus of the blood circulating through 
them, the peristaltic motion of the intestines must 
hasten its circulations both through them, and the 
mesenteric veins. With the greater impetus the 
blood in its reflux through the mesentertic veins 
strikes against the sides of the vena porta ventralls to 
mingle with the blood from the gastric and splenic 
♦veins, the more rapid must its circulation be in the 
vena porta hepatica through the substance of the 
liver, and the greater must be the quantity of bile 
secreted in a given time by that viscus. The great- 
er the quantity of bile secreted in a given time, the 



BILIARY CONCRETIONS. 121 

more watery and bland will it be. This we infer from 
the general properties of all secreted fluids, and from 
the analogy of the liver to other secerning glands. 
If a man be so affected with grief as to weep inces- 
santly for a considerable length of time, after a 
while his tears cease to be acrid or corrosive. 
When a person takes large portions of diluent drinks 
his urine soon becomes limpid and tasteless. Slow- 
ness of circulation seems essential to the progress of 
absorption. / By stagnation the thinner and more 
watery parts of all secretions are reabsorbed and car- 
ried back into the general circulation. This is prov- 
ed by the urinous smell emitted from the perspirable 
matter of persons for a long time affected with stran- 
gury, and by the faecal smell of the cutaneous ex- 
cretions of those labouring under obstinate costive- 
ness. We have the authorities of all modern phy- 
siologists and anatomists for the numerous absorbent 
vessels of the liver. The languid motions of that 
important viscus in a peculiar manner favour the 
absorption of the more watery parts of the bile. The 
remaining portion of blood, after the bile is secreted 
circulates through the hepatic veins to the vena ca- 
va ascendens. Thus it is proved that both the quan- 
tity and quality of the bile depend very much upon 
the tone and vigour with which the chylo-poietic 
viscera perform their functions, that the viscidity 
or tenacity of this substance arises from the absorp- 
tion of its more watery parts, while it stagnates in 
the liver and gall-bladder. 



122 A DISSERTATION 1 ON 

The emptying of the bile after its secretion into 
the intestinum duodenum also partially depends 
upon the vermicular motion of the intestines, the 
ductus communis choledochus not possessing suffi- 
cient susceptibility to contraction from the stimulus 
of the bile to force it out without the co-operation of 
other causes. This may be inferred from the greater 
proportional excretion of bile in relation to the 
secretion, while emetics or cathartics are acting upon 
the stomach or bowels, and from the gall- duct and 
bladder being invariably found full of viscid bile, 
when the stomach and intestines have been torpid 
any considerable time before death. Surrounded on 
all sides by parts endued with great muscular con- 
tractility, the liver is much indebted for its motions 
to the vigorous impulse communicated by its neigh- 
bours. Not only the stomach and bowels, but the 
diaphragm, the lungs, the intercostal and abdominal 
muscles are continually pushing it on all sides. 

Having traced out the connexion between the 
the liver and surrounding parts, and shewn its great 
dependence in the exercise of its functions upon the 
tone of the stomach and feowels, the way is -now pre- 
pared for a more thorough investigation of the causes, 
remote and proximate , of biliary calculi. 

After bile, unusually viscid from the torpid 
state of the liver and absorption of its thinner parts 
in consequence of its long stagnation in that viscus ? 



BILIARY CONCRETIONS. 12$ 

is poured 'from the port biliarii into the hepatic duct, 
it passes through that to the common gall-duct, 
from which it regurgitates through the cystic duct 
to the gall-bladder. Here suffering another long 
stagnation from the torpid state of the stomach and 
bowels, the thinner aqueous parts of the bile exhale 
and are reabsorbed into the general circulation 
while the thicker settle to the bottom of the vesicula 
fellis, there gradually harden from the loss of their 
principles of solution, until they eventually become 
the first layer or nucleus of the future gall-stone. 
Upon the influx of a fresh portion of bile into the 
gall-bladder, the thickest and saline particles attach 
themselves to the concretion already formed, and 
there chrystaliize, forming another concentric lamina. 
In this manner one or more gall-stones are formed 
in the gall-bladder, where they may remain perfectly 
harmless for a series of years, provided they do not 
fall into the duct, nor become impacted in its mouth 
so as to obstruct the flow of cystic bile into the duc- 
tus communis choledochus. 

I recollect having been present a few years ago 
at the examination of a man who had died hectical 
at the age of sixty-five or seventy from an inguinal 
abscess. He had been remarkably robust during 
his whole life until just before his decease, and when 
he died the cells of his adipose membrane were 
much distended with fat. Upon making an incision 
into the gall-bladder, seven chocolate-coloured gall 



124 A DISSERTATION ON 

stones of a prismatic form, perfectly smooth and pol- 
ished, about the size of common beach-nuts, were 
discovered. He had never been troubled with any 
disease of the liver from that source. Authors are 
full of similar cases. 

When the action of any cause has forced them 
into either of these ducts, and there they have be- 
come so impacted as to obstruct the flow of bile into 
the duodenum, they become the source of incalcu- 
lable mischief to the constitution, bringing on jaun- 
dice with all its frightful train of symptoms, spasm, 
convulsion, and even death, if relief be not afforded, 
either by medicine, or the accidental removal of the 
cause. 

As a description of the valuable purposes sub- 
served by the bile in the process of digestion will 
reflect light upon the train of symptoms which pro- 
ceed from its obstruction, it will be proper here to in- 
troduce the chemical, chylo-poietic, and cathartical 
history of that fluid. In the first lines of Haller's 
Physiology, p. 353, is the following account of the 
bile. 

" It therefore is a soap ; but of that sort which is 
composed of a volatile alkaline salt, mixed with oil, 
and retains its water. Therefore being intermixed 
with the aliment reduced to a pulp, and expressed 
from the stomach by the peristalic motion of the 



BILIARY CONCRETIONS. 125 

duodenum and pressure of the abdominal muscles, 
it in great measure overcomes the acescent qualities 
of the food, it dissolves the coagulum of milk, and, 
disposes the aliment more to putrescency ; it dis- 
solves the oily matters, so that by freely incorpo- 
rating with the watery parts, they may form chyle 
and the more readily enter the laeteals ; it absterges, 
and attenuates the mucus ; and lastly excites the pe- 
ristaltic motion by its acrimony." Morgagni, Sa- 
batier, and Monroe agree pretty exactly with the 
above writer in their descriptions of the physiologi- 
cal uses of the bile in promoting digestion. 

Were all the symptoms from obstruction to the 
flow of bile from the presence of biliary concre- 
tions in the gall-ducts to be described by reasonings 
a priori, spasm from the irritation of the gall-stone 
being set aside, and Haller's history of the bile being 
the data, the most material symptoms would be as 
accurately described, as though they had been pen- 
ned by one, who had watched the disease in its va- 
rious stages. 

The following are the most general phenomena 
of the disease, viz. languor, depression of spirits, 
yellowness of the adnata and afterwards of the whole 
skin, anxiety, respiration occasionally difficult, pain 
about the scrobiculus cordis and through the right 
shoulder, loss of appetite, costiveness alternating 
with a relaxed state of the bowels, clay-coloured 



126 A DISSERTATION ON 

stools an 1 dyspepsia with all its attendant pains from 
an acid fermentation of the chyme and the conse- 
quent disengagement of elastic vapours, producing 
distention and eruetations of wind, which are acid to 
the taste. The urine gives a yellow dye to linen. 
A low, quick, and somewhat tense pulse is likewise 
a symptom, which frequently accompanies the com- 
plaint. Dr. Saunders says it is sometimes slower dur- 
ing the passage of the gall-stone. False vision as it 
relates to the colour of objects is said to be an occa- 
sional symptom ; as are likewise false taste as it re- 
lates to a sensible bitterness in all sapid bodies re- 
ceived into the mouth, and a febrile diathesis. 

* " A very troublesome itching, but without 
any eruption, is often observed in jaundice. In a 
simple jaundice without any apparent disorder of the 
liver, or other viscera, a hiccup will now and then 
join itself to the other symptoms, but without de- 
noting any present or future mischief. In other 
disorders of the bowels it is a very alarming symp- 
tom to have the patients subject to fits of shivering: 
but very strong ones now and then happen in the 
jaundice, and last an hour, and return every day for 
two or three times without being followed by any 
other complaint. It is difficult to guess satisfactori- 
ly at the cause of this ; but whatever it be, I have 
suspected, that this symptom, happens at the time 

Heberden upon Jaundice, Lond. Med. Trans, vol. 2nd. p. 338. Sec. 



BILIARY CONCRETIONS. 127 

of the stones passing into the intestines. However 
neither suppuration, nor gangrene, nor any other 
mischief needs be apprehended from this shiver- 



When the gall-stone has sharp angular edges, by 
pressure against the internal coat of the bile duct, it 
checks the vital action of the part thus irritated, 
and this check of action is first communicated to the 
duodenum and stomach, afterwards to the whole 
system. 

In the reactions of the system or efforts made to 
recover their accustomed action, the stomach and in- 
testines are spasmodically affected, and sometimes 
are inverted in their actions. There is no part of the 
living body, however feeble its powers of life or small 
its natural sensibility, which is not capable of acquir- 
ing a high degree of morbid sensibility ; thus liga- 
ments, tendons, and bone, which in their healthy 
state possess little or no sensibility, in a diseased 
one acquire a morbid sensibility so acute as to be 
pained by the action of the least irritating cause ; 
likewise the liver, the sensibility of which in its 
nealthy state is relatively small, can acquire a morbid 
sensibility, which will render a slight irritation ex- 
cruciatingly painful. The pain attending the sever- 
est paroxysm of colic in the most irritable habits 
from the presence of sharp angular gall-stones in the 



128 A DISSERTATION ON 

common biliary duct cannot be more forcibly ex- 
pressed than in the following language of Virgil. 

— — - rcstroque immanis vultur obunco 
Immortale jecur tundens, fcecundaque poenis 
Viscera rimaturque epulis, habitatqne sub alto 
Pectore ; nee fibris requies datur ulla,* 

so long as the excessive irritation and spasm con- 
tinue. 

"Those who have once had this distemper, are 
very liable to returns of it, not only because other 
gall-stones are liable to be generated by the same 
causes which formed the first, but likewise because 
a fit of the jaundice is frequently terminated, not by 
the passing of the stone into the duodenum, but by 
its falling back into the cystis ; at its passing out of 
which it occasions a fresh fit, and many may thus be 
caused by the same stone.' ' 

" I attended a woman, who for five years labour- 
ed several weeks every year under all the usual 



* A ravenous vulture, in his opened side, 
Her crooked beak and cruel talons try'd ; 
Still for the growing- liver digged his breast ; 
The growing liver still supply 'd the feast ; 
Still are his entrails fruitful to their pains ; 
The immortal hunger lasts, the immortal food remains- 

Bryden's Translation of Virgil, Book vi. L 808—13. 



BILIARY CONCRETIONS. 129 

symptoms of the jaundice in the highest degree. In 
the sixth year she voided a gall-stone like a small 
olive in shape and size ; since which time she has 
enjoyed good health for many years without any re- 
turns of the jaundice, or the appearance of a disorder 
which could be attributed to her once having had it."* 

Obstruction to the How of bile from biliary con- 
cretion is liable to be confounded with obstruction 
from spasm upon the orifice of the common gall 
duct, with its obstruction from a paralysis of the liver 
and of its excretory ducts, with its obstruction from 
the obliteration of the common gall-duct, with its 
obstruction from the too great viscidity of the bile 
accompanied by a languid vermicular motion of the 
duodenum, and with its obstruction from schirrous 
tumours or scrophulous enlargements of some of the 
abdominal viscera pressing against the gall-duct, 
and thereby shutting up its passage. The diag- 
nosticks by which the above various causes produc- 
ing effects so very similar can be discriminated 
from each other are to be sought in the history of 
the state of the system, before and during the first 
stages of the complaint. 

If spasm upon the orifice of the gall- duct ter- 
minating in the duodenum be the obstructing cause 7 



* Of the Diseases of the Liver, by William Heberden, M. D. Loiv 
don Medical Transactions, vol, 2nd, p. 123. 

R 



130 A DISSERTATION ON 

the symptoms must have been sudden in their ap- 
pearance ; and antispadmodics afford immediate re- 
lief, sublata causa, effectus tollitur ; whereas when 
gall-stones fill up the cavity of the biliary duct, they 
must be forced out before a cure can be effected. 

If schirrous tumours or scrophulous enlarge- 
ments of some of the abdominal viscera be suspect- 
ed as the cause of the difficulty, and they cannot be 
satisfactorily traced out by the sense of feeling, dis- 
crimination would be comparatively unimportant, 
for a course of calomel or the long and faithful use 
of the cicuta are equally proper in curing the symp- 
toms proceeding from both sources. If the patient 
have a scrophulous habit of body, the cicuta should be 
administered ; otherwise the mercurial course would 
be most proper in removing the schirrous affection. 

When an adhesive inflammation upon the in- 
ternal coat of the ductus communis choledochus has ob- 
literated the passage of that duct by converting it in- 
to a solid cord, the disease is absolutely irremedia- 
ble ; but the rareness of obstructions to the flow of 
bile from this cause and the hopeless situation of the 
patient after itionce exists, should induce the practi- 
tioner never to suspect its existence, before all possi- 
ble remedies iin all their various modes of being ad- 
ministered have been tried without success. 

If a paralytic state of the liver or its excretory 
ducts be the origin of the difficulty, the pain is less 



BILIARY CONCRETIONS. 131 

severe than when gall-stones stop up the passage of 
those ducts, and the disease readily yields upon the 
application of electricity to its seat, or to any other 
stimulus sufficiently powerful to rouse that sluggish 
organ into action. 

The discrimination of obstruction to the flow of 
bile, proceeding from its too great viscidity accompa- 
nied by a feeble vermicular motion in the duodenum, 
from obstruction originating in the presence of gall- 
stones in the common or cystic duct cannot be very 
important, as they are only different degrees of the 
same disease, and can require for their cure only 
different forces of the same remedies. 

As biliary concretion is by far the most frequent 
cause of obstruction to the flow of bile into the duo- 
denum, a trifling suspicion of the existence of other 
causes should not influence the prescriptions of the 
practitioner in the least. Thus Haller in his Ele- 
menta*Physiologiae, when speaking of biliary con- 
cretion, says, that the disease is common ; much 
more frequent than stone in the urinary bladder, al- 
though it is for the most part concealed under the 
name of colic. 

The following are his words — " Invenio euro, 
morbum vulgarem esse, multo frequentiorem calculo 

* Vol. vi. p. 564?. § xiL 



132 A DISSERTATION ON 

urinaria vesicae, esti plerumque sub colicae nomen 
latet." 

The remedies to be employed in the cure of this 
disease naturally present themselves for our consid- 
eration in two classes, 1. Those, which are only 
palliative of the pain during its almost insupportable 
sererity, and 2. Those, which operate a permanent 
cure. 

1. It has already been stated, that a check of ac- 
tion in the gall duct from the irritation of a sharp, 
angular gall-stone against its morbidly sensible inter- 
nal coat, sometimes communicates its influence ex- 
tensively to the rest of the system, exciting colicy 
pains in the stomach and bowels, and bringing on 
general spasm. The indication in this case is the 
use of such remedies as effect a relaxation of the 
fibre. These comprehend blood-letting, warm bath, 
opium, and the general list of antispasmodics. If 
the pulse be tense, blood must be drawn. The 
quantity should be regulated by the state of the sys- 
tem. Should blood-letting prove insufficient, or 
should not the pulse indicate it, warm-bath and 
opium must be immediately resorted to for taking 
off the spasm and removing the pain. The opiate 
may be administered, while the patient is in the 
bath. Its use should be pushed indefinitely, to be 
commenced in small doses and repeated at short in- 
tervals, until it has produced the desired effect. 



BILIARY CONCRETIONS. 133 

Were it allowable to prescribe a priori without the 
aids of experience in relation to the operation of the 
remedy, I would suggest the propriety of passing re- 
pe ited galvanic or electric shock s through theliver from 
right to left, in the direction of the cystic and common 
gall-ducts, and continuing them downwards through 
the duodenum, while the opium and warm bath are 
in full operation. It seems not improbable, that t] e 
galvanism or electricity would excite the cystic and 
common ducts to such powerful contractions, alter- 
nating with a proportional relaxation of the fibre 
and consequent expansion in the diameter of the 
tubes, as must propel the gall-stone, or stones into 
the duodenum. 

II. The class of remedies, which operate a per^ 
manent cure, admit of subdivision into three orders. 
1st. Those, which act mechanically; 2nd. Those, 
which act chemically, and 3d. Those which have an 
action compounded of the two, i. e. a chemico-me- 
chanical action. 

1st. By remedies which act mechanically, I 
would not be understood to mean those, which cure 
by any deobstruent power, derived from the ponde- 
rosity, or spicular shape of the particles ; but such 
as either stimulate the fibre to contraction, or diffuse 
freedom of motion and its consequent vital warmth 
through every part of the system, by producing an 
equable and properly balanced action in every fibre. 



134 A DISSERTATION ON 

I apply the epithet mechanical to this order of rem- 
edies, not from any partiality to j the word, but be- 
cause I can find none more appropriate in distin- 
guishing it from that order, whose actions are decid- 
edly chemical. 

This order of remedies embraces, 1st. Emetics, 
2d. Cathartics, 3d. Emetico-cathartics, 4th. Incitan- 
tia, or general stimulants, and 5th. Sedatives, or 
those remedies, which, though their first operation 
may be stimulant, eventually relax the fibre and 
allay spasm. 

1st. If the gall-stones be small, emetics of tartar- 
ized antimony, or ipecacuanha, are fully sufficient to 
remove all the symptoms. Dr. Saunders, in his 
valuable treatise upon the Liver, under the article of 
Jaundice from Biliary Calculi impacted in the cys- 
tic or common gall- duct, advises to the use of ipe- 
cacuanha in preference to other emetics, to be ad- 
ministered however in such small divided doses as 
to excite considerable nausea before puking actually 
commences. Tartar Emetic I have seen successful 
in removing obstruction, after the ipecacuanha had 
failed. 

Dr. Darwin recommends half a pint of olive-oil 
to be given as an emetic during the paroxysm of 
spasm, and to be repeated at proper intervals in the 
same dose until it operates. 



BILIARY CONCRETIONS. 135 

2nd. Cathartics operate a cure by stimulating the 
duodenum to such a brisk vermicular motion, as is 
adequate to the propulsion of the gall-stone from its 
narrow%ed in the bile duct into the cavity of that in- 
testine. If the biliary concretion be small in rela- 
tion to the diameter of the tube through which it must 
pass, cathartics of some kind possess a force best 
accommodated to the force of the disease, and of 
course are to be used in preference to the other rem- 
edies. Pil. coc. and calomel, or jalap and calo- 
mel, as possessing universal stimulant powers and 
being at the same time perfectly harmless in their 
operation, should be preferred to most other cathar- 
tics. Dr. Darwin says he has in repeated instances 
procured the evacuation of biliary calculi by admin- 
istering calomel grs. vj. at night, and follow it in the 
morning with a dose of oil. 

3d. Emetico- cathartics claim a decided prefer- 
ence to either emetics or cathartics alone, for they 
act with the joint force of both. Calomel and tartar 
emetic form a most valuable remedy in forcing open 
the bile ducts and procuring a free discharge of that 
fluid from the liver. This mixture acts, with great 
certainty and effect, both as emetic aud cathartic. If 
the irratability of the habit forbid the use of tartar- 
emetic, ipecacuanha may be substituted with near- 
ly the same promise of success. 



136 A DISSERTATION ON 

The following are common doses of these arti- 
cles for an adult, to be administered however in di- 
vided portions. 

# 
R. Tartarized Antimony. grs. ij. 

Sub-muriate of Mercury. grs. viij. 
M. or 

Be. Pulv. Ipecac. 9 i. 

Calom. ppt. grs. viij. 

M. 

If one emetico- cathartic do not remove the ob- 
struction, it may several times be repeated according 
to the symptoms of the complaint and the constitu- 
tion of the patient. 

4th. Incitantia or general stimulants compre- 
hend mercury, galvanism, electricity, canthurides y &x. 

Calomel combined with opium in such doses 
and repeated at such intervals as slightly to affect 
the glands of the mouth, succeeded by cathartics to 
prevent mercurial action proceeding to salivation 
and to excite an increased peristaltic motion in the 
intestines, experiment has proved to be a very 
efficacious remedy in removing obstructions to the 
flow of bile from the concretions of that fluid in the 
gall-duct. 



BILIARY CONCRETIONS. 137 

In some cases it may undoubtedly be necessary 
to excite salivation, and to maintain it a considera- 
ble length of time. Dr. Gibbons * has given a re- 
port of thirteen cases of biliary obstruction from cal- 
culi, twelve of which were cured by salivation. 
Many of his patients were far advanced in life, 
One of his patients after a ptyalism of three weeks 
standing, excited by the internal use of calomel, void- 
ed three biliary calculi, each weighing ten grains. 
He remarks, " From this it seems to appear that 
the mercury did not act upon the calculi, but so re- 
laxed the ducts as to facilitate the exit of the stones." 
He proceeds, " But let us review the first five cases, 
where every patient was cured, and no gall-stones 
found in the faeces. May we not reasonably sup- 
pose, as none of those patients had any return of 
the disorder, that the mercury in those cases acted 
as a solvent?" 

This same gentlemen concludes the history of 
case xij with the following remarks. " There is 
great reason to suppose from the knotty state of the 
liver after the bile had got a free passage, and the 
tumour lessened, that not only the ductus cysticus, 
and ductus hepatius, but that the pori biliarii were 
likewise obstructed ; for I do not think it possible 
for a human gall bladder, to contain a fourth part 
of the calculi she voided, not much larger than. 

* Duhoan's Ajinals of Medicine, vol. L p. 27"9, &c. 

s 



138 A DISSERTATION OK 

sand. Did the mercury in this case diminish the 
size of the calculi ? The lady had resolution enough 
to persevere in the use of her medicines, and spitting 
to the end of the month or some time longer ; and 
happily got rid of her disorder. #There was one 
stone voided, the last that passed, about the size of a 
pea*" 

In cases where the mercury taken internally could 
not be made to act upon the glands of the mouth, 
from the relaxed state of the bowels, I have known 
mercurial inunction over the region of the liver at- 
tended with the happiest effects. It is the practice of 
the English physicians and surgeons in the East- 
Indies to cure jaundice from biliary concretion by 
the use of calomel, as the East- India* correspondent 
of Dr. Saunders clearly shews. It is recommended 
by some medical authors to alternate the use of 
calomel with emetics. 

The torpid state of the stomach, bowels, and liver 
indicate the passage of frequent shocks of galvan- 
ism or electricity through the several regions of the 
abdomen. Tincture of cantharides may be rubbed 
over the abdomen with advantage. If the irritations 
of the gall-stones produce any degree of inflamma- 
tion in the liver, which may threaten suppuration, 
large blisters should be successively applied over 
the right hypochondria, until the tumour is discussed. 

* Saunders on The Liver, p. 172 ; vide note. 



BILIARY CONCRETIONS. 139 

5th. Sedatives are comprehended in that list of 
remedies, which produce a universal relaxation of 
the fibre. These are blood-letting, and certain nar- 
cotic vegetable products, together with warm-bath. 
They are mostly contained in the class of palliatives, 
or those remedies employed only in procuring tem- 
porary ease during the paroxysms of severe convul- 
sive pain. 

Provided the patient be of a plethoric habit, and 
have a tense, labouring pulse, blood-letting should be 
practised pro re nata. 

Of the narcotics, or antispasmodics, opium is the 
most powerful. The virtues of the common opium 
would be greatly enhanced in the cure of this com- 
plaint, provided it did not constipate the bowels at the 
same time it removes spasm, by diminishing the sus- 
ceptibility of the fibre to contraction. Notwith- 
standing opium increases costiveness, it has been 
employed with very great success in the cure of bil- 
iary concretion. It not only diminishes pain, but 
produces great relaxation of the fibre to facilitate the 
passage of the gall-stone. In the Memoirs* of the 
Medical Society of London, Dr. Lettsom has re- 
ported a case of jaundice from biliary concretion, 
which was cured by Thebaic tincture, warm bath, 
and gentle laxatives, together with laxative anodyne 

* Vol. i. p. 374. 



140 A BISSERTATIOtf ON 

injections. The pain had been severe at short in- 
tervals for a very considerable time. Three hundred 
drops of Thebaic tincture were administered daily, 
for two or three days in succession. Castor oil was 
taken into the stomach on the same day, as a pur- 
gative, and likewise mixed with anodyne injections 
to be administered per anum. At length a gall-stone 
of the following dimensions was voided — • 

Length — 2,25 inches. 

Circumference — 3,25 inches. 

Weight — Si. 3ij. 9i. grs. iij. 

For the two or three days succeeding the passage 
of the above-described gall-stone, the patient took 
three hundred drops of laudanum ; but afterwards 
was completely cured of the complaint. 

It is said there are preparations of opium, which 
rather increase than diminish the alvine discharges. 
If this be true, they must form a valuable remedy 
for the removal of biliary concretion. 

Conium maculatum, or cicuta, is a powerful re- 
laxant of the fibre. The dilatation produced by it 
in the pupil of the eye, when administered in the 
full dose, demonstrates its efficacy in diminishing 
muscular contractility. 

Dr. Fisher prescribed this remedy several times 
in cases of jaundice from biliary concretion with the 



BILIARY CONCRETIONS. 141 

most perfect success. This veteran in the healing 
art explains the modus operandi of the cicuta, in re- 
moving obstruction to the flow of bile, from the 
presence of calculi in the gall-duct by its antispas- 
modic qualities. He administered it in small doses 
at first, increasing them however until he arrived at 
the extent the stomach could bear them. In the 
course of a very few days by this practice he pro- 
cured a free discharge of bile into the duodenum. 

Dr. Prescott of Groton, in a communication to 
the Massachusetts Medical Society, relates a case, 
where chronic pain in the region of the stomach pro- 
ceeding from biliary concretion had been relieved 
by smoking tobacco. The patient called her com- 
plaint colic. (o) Upon dissecting her body after 
death, which was produced by a rupture of the ute- 
rus in parturition, one hundred and fourteen gall- 
stones of various sizes were found in the gall-bladder. 

II. The second order of the second class in our 
division of remedies, which are to be used in the 
cure of biliary concretion, embraces all whose ac- 
tions are decidedly chemical. Before proceeding 
however to the consideration of this order of reme- 
dies, it will be proper to investigate the chemical 
properties of gall-stones. In the history already 
given of their formation, the increased viscidity of 
the bile, from its long stagnation in the liver, origi- 
nating in a feeble peristalic motion of the intestines 



J42 A DISSERTATION ON 

has already been noticed. Mention has already 
been made of the absorption of the more watery 
parts of the bile after its reception into the gall- 
bladder, where the thicker portions of it agglutinate, 
and in some instances undergo a kind of crystalli- 
zation, as the fracture of some gall-stones clearly 
demonstrates. 

M. Sabatier calls the process of concretion in 
the bile, the thickening and drying up of the bile„ 
V Gpaississeiiient £s? le dessechement de la bile being 
Ms description of the formation of biliary concretion 
in the gall-bladder. Be this as it may, if accident, 
disease, or any cause whatever, produce any thing in 
the gall-bladder, which may serve as a nucleus, 
round which the grosser particles of the bile may 
collect, biliary concretions are the inevitable con- 
sequence. 

Hence all the constituent principles of the gall- 
stone must have as much pre-existed, variously 
modified in the gall, as all the constituent principles 
in the crystals of nitre must have pre-existed in the 
nitrous solution, before the act of crystallization had 
taken place, notwithstanding the suggestions of even 
Dr. Saunders to the contrary. 

It has likewise been stated, that all physiological 
and most chemical writers agree in calling the 
bile an animal soap, formed by the triple union of a 



BILIARY CONCRETIONS. 143 

line animal oil with a sub-alkaline water, holding 
certain other principles in solution, as mucilage, 
soda, &c. Monroe in the second volume of the Ed- 
inburgh system of Anatomy,* says the bile is a nat- 
ural soap made from a volatile saline lixivium , mixed 
with oil and water. If this be a true description of 
that fluid, gall-stones are little else than a concrete an- 
imal oil, containing the water of crystallization, and 
slightly impregnated with ammonia. Much the 
greatest portion of the water must have been reab- 
sorbed into the general circulation, and along with it 
must have escaped a part of the volatile alkali, the 
affinities between that article and oil being too 
small to be retained long even in volatile liniment, 
the temperature of which is much below animal heat. 
But deductions respecting the constituent principles 
of biliary concretion from the known constituent 
principles of bile concerned in forming the concretion 
we shall leave for the chemical history of Biliary Cal- 
culi founded upon actual experiment by M. Four- 
croy.f 

" I bwt been led to think, that the cause of the 
production of these calculi depended upon the cir- 
cumstance, that this oily matter becoming too abun- 
dant by a particular disposition of the bile to remain 
in solution in it with the aid of the soda, and this hu- 

* Saunders on the Liver, p. 101. 

f Fourcroy's Chemistry, vol. x. p. 73, 81. 



144 A DISSERTATION OK 

mour being by the same disposition thick, and tend- 
ing to concretion, a crystallization of this substance 
took place, sometimes pure and insulated, sometimes 
mixed with a more or less considerable proportion of 
biliary matter, and that the different forms which 
it affected in its precipitation, depended upon the 
slowness or the rapidity with which it was deposit- 
ed. As this matter proceeds manifestly from the 
concrescible oil of the bile, and as a vegetable resin 
never assumes a nature similar to that of adipocire, I 
have thence concluded that the oily matter of the hu- 
man bile is not a resin, but a substance more or less 
analogous to spermaceti, a real adipocire, suscepti- 
ble of assuming the concrete and^ crystalline form 
under certain circumstances. 

" I now reckon six genera of biliary calculi : The 
first are the bilious -hepatic, composed almost solely 
of thickened bile, deposited in irregular clots in the 
texture of the liver itself: these are rare. 

"The second "are the hepatic-adipocirous ; they 
are found sometimes in narrow laminae, forming solid 
points in the parenchyma of this viscus ; sometimes 
they are prominent upon its surface, exhibiting small 
white or yellowish tumours : they are very rare in 
this place ; frequently, perhaps, very small ones of 
this kind are discharged, and *un off with the bilous 
evacuations. 



BILIARY CONCRETIONS. 145 

"The third I call cystic bilious: these are con- 
crete balls, or flakes of thickened bile, granulated, ir- 
regular, very various in form and consistence, some- 
times friable, brown, or reddish. The calculi of the 
gall-bladder of the bullock, which the painters use, are 
of this kind. 

" The calculi of the fourth genus are the cortical, 
of the same nature with the preceding ; they are only 
more dense and covered with a grey, or white smooth 
layer, well terminated with adipocire. They hold 
the second rank with respect to their frequency. 
They are frequently found in great numbers in the 
gall-bladder ; sometimes even they exceed a hundred 
in number : they are then polygons, situated close 
to each other like pieces of mosaic work, and distend 
the bladder more or less. 

" The fifth genus consists o£ the cystic adipocir- 
ous calculi ; they are white or grey, opaque without, 
or semi-transparent, granulated or smooth, covered 
with a crust of short filaments, or without crust, 
formed of entire lamina in their whole thickness, "or 
of rays proceeding from the centre, and diverging to 
the circumference : very frequently they are single, 
and they have the size and form of pigeons' eggs. 
They are more rare than the preceding ; they are 
mostly found in women. At the termination of bili- 
ous diseases, and almost always of chronic jaundice, 

irregular calculi of this sort s somewhat drv'or solid, 

T 



146 A DISSERTATION Off 

rather granulated than crystalline, soft, similar to tal- 
low, and yellowish, are discharged with the stools. 

ci This kind of adipocirous, or fatty evacuation,. 
Is much more frequent than has been believed, and 
may be observed in many subjects when their dejec- 
tions are carefully examined at the termination of dis- 
eases. 

" Finally, I refer to the sixth genus the mixed 
cystic, or adipo-bilioas calculi, which are mixtures of 
adipocire and thickened bile in various proportions : 
these are most frequent of all, and like those of the 
fourth genus, they are numerous ; they are frequent- 
ly found mixed with them ; sometimes brown, or of 
a deep green of olive colour, we see more or less 
easily in their interior, brilliant streaks or lamellae, 
of a deep yellow colour, or only some micaceous 
points. When they are polyhedral, we observe upon 
their worn sides, edges of broken crystalline laminae. '* 

According to this history of bile and of biliary 
concretion, alkalis must make the best menstrua for 
the solution of the gall-stones. By combining a 
greater than ordinary portion of alkali with the blood, 
the newly secreted bile must of course become sur- 
charged with that article. According to one of the 
laws of affinity of composition, the attraction of the 
particles of one body for those of another is in the 
inverse ratio to their saturation with each other. If 



BILIARY CONCRETIONS, 147 

this law hold true when applied to the present case, 
the excess of alkali in the newly secreted bile, upon 
its arrival at the vesicula fellis, must immediately en- 
ter into chemical union with the animal oil, or adu 
pocire, constituting the principal ingredient in the 
gall-stone, dissolve down its sharp angular edges, lu- 
bricate its whole surface by softening its external 
stratum, and thereby favour its expulsion through the 
common gall-duct into the duodenum by the ver- 
micular motion of that intestine. 

But the products .afforded by the analysis of 
gall-stones have been different, when they have 
been analyzed by different phisiologists and 
chemists. 

This is readily accredited, for additional to the 
new compounds which would be likely to be made 
in submitting gall-stones to the action of fire and of 
the different menstrua, into which they are immersed 
for solution, the varieties of bile, and of course, the 
varieties of concretion from that bile, must be as 
great as the constitutions of different people affected 
with biliary concretion are different. 

Morgagni describes two kinds of biliary concre- 
tion. Though both possess in common the prop- 
erty of swimming upon the surface of water, they 
have different colours, and exhibit different phenom- 
ena, when exposed to the action of a burning taper* 



148 A DISSERTATION ON 

While the one bums with a vivid flame until it is 
entirely consumed, the other puffs up, melts, and 
falls down in drops, being but partially consumed, 
and emitting an odour peculiarly fetid. It is a max- 
im, which obtains among all modern physiologists, 
that diseased fluids are almost invariably the result 
of diseased solids, the specific qualities of the fluids 
secreted depending upon the specific actions of their 
secerning solids. Any change of action, whether 
morbid or not, must produce a corresponding change 
in the fluid secreted by the action of its secerning sol- 
id. This accounts for the difference in the different 
confcntric laminae, which are sometimes discovera- 
ble in the same gall-stone, and for the great variety 
in different gall-stones 

When the bowels are constipated for a length of 
time, the mucilage, which forms a greater or less 
proportion of all the aliments used in diet, is proba- 
bly absorbed by the lacteals in too great quantities. 
The blood, having a redundancy of that article, in 
its languid circulation through the liver, would 
probably supply the bile with a surplus. 

The position respecting the variety of biliary 
calculi may be extended. The product, from the 
multiplication of the variety of animal action in the 
different people affected with biliary concretion, 
into the variety of aliments used by those people, 
and all the permutations and combinations of which 



BILIARY CONCRETIONS. 149 

such product is capable, must furnish all possible 
varieties in the structure and composition of gall- 
stones. 

If. they are composed of earthy, resinous, and 
mucilaginous matters, combined with certain saline 
substances, in some cases, as Dr. Saunders thinks 
he has shewn them to be in the analysis he made of 
them, an alkaline solution, or, in other words, bile 
supersaturated with the article, upon coming in con- 
tact with the gall-stone, must act upon it, soften its 
hardened edges, and lubricate its surface generally. 
If the gall-stone be very hard, it may be necessary 
to persevere for a considerable length of time in the 
use of the remedy, before it will produce the desired 
effect. 

Although Dr. Saunders acknowledges, that bil- 
iary calculi of the above description are soluble in 
alkaline menstrua out of the body, still he virtually 
denies the efficacy of alkaline remedies in procuring 
their solution in the body, when he says, It remains 
yet to be proved that the proportion of alkali in the 
bile is increased by alkaline medicines. Many saline 
remedies, continues our author, pass into the urine 
unchanged, but we cannot detect the presence of alka- 
line or of other solvents in the bile : the analogy there- 
fore betzveen the action of solvents in biliary and uri- 
nary calculi will not obtain. Here is a conclusion 
founded upon a broad assertion, which, in the Ian- 



150 A DISSERTATION ON 

guage of its author, remains yet to be proved. 
When he tells the reader, that saline remedies pass 
into the urine unchanged, he indirectly admits, that 
they have a previous circulation with the blood, for 
nothing can reach the kidneys without a previous 
circulation through the heart and arteries. That 
the Dr's position, relative to no increment in the al- 
kalescency of the bile from alkaline remedies taken 
into the stomach, may be true, he must prove an 
appetency (a non-descript of Darwinian discovery) 
in the mouths of the renal arteries to receive the sa- 
line particles of the blood, which the mesenteric and 
splenic do not inherit in common with their neigh- 
bours ; or he must prove, that the saline particles of 
the blood circulating through the chylo-poietic vis- 
cara are absorbed by the lymphatics and carried 
back into the general circulation without being pre- 
sented to the patulous mouths of the minute veins, 
which unite to form the vena-porta ventralis. Nei- 
ther of these hypotheses, which have been assumed 
to preserve the Dr's consistency with himself, can 
be substantially correct, for he informs us, that he 
found both soda and ammonia * in the gall stones 
he analyzed. 

The suggestions, opinions, and theories of med- 
ical writers deserve a scrutiny, severe in proportion 
to the celebrity of those writers, and the relations 

* Saunders On The Liver, p. 106. 



BILIARY CONCRETIONS. 151 

those suggestions, opinions, or theories may bear to 
the practice of the healing art. The celebrity of 
Dr. Saunders, and, of course, the plausibility of ev- 
ery speculation stamped with the sanction of his 
name, must justify the above strictures upon the 
opinions advanced by that eminent physician. But 
with mere reaso?iing we will not oppose so respecta- 
ble an authority as Dr. Saunders. 

* " All these calculi, being soluble in the caustic 
alkalies, in the solution of soap, are made to yield and 
disappear, or soften, and even dissolve by the use of 
these medicines when they are able to reach them. 
They ought to be attacked with these remedies, adr 
ministered in a judicious manner." 

Of the alkalies, soda as being least caustic, and 
consequently least apt to corrode the internal coats 
of either the stomach, intestines, lymphatic or 
blood-vessels, through all which it must pass before 
arriving at the liver, is to be preferred. Notwith- 
standing soda forms a harder soap when combined 
with oil and water than potass, the aqueous portions 
of the bile at the temperature of animal heat must 
preserve a sufficient fluidity in the compound to fa- 
vour the action of the mineral alkali upon the gall- 
stone. 



* Fourcroy's Chemistry, vol. x. p. 82. W. Nicholson, London, 1804. 



152 A DISSERTATION ON 

Both of the fixed alkalies have however been 
proved by the touchstone of correct practice, experi- 
ment ; , to be valuable remedies in curing jaundice 
from biliary concretion in the gall-duct. Among 
the labouring farmers in many parts of the interior 
f of New- England, if any one feel the symptoms of 
an incipient jaundice at the commencement of the 
warm weather in the spring, the ley of wood-ashes 
steeped in his morning draught of cyder, is his first 
remedy, and that perseveringly used generally 
proves adequate to the removal of all his difficulties. 

Alkaline remedies, in the cure of biliary concre- 
tion have other advantages than those derived from 
their passing into the general circulations. The 
stomachs of those affected with obstructions to the 
flow of bile into the duodenum, from torpor, secrete 
a gastric liquor insufficient for the entire solution of 
every thing received into them as articles of diet, 
and consequently their food must undergo more or 
less of an acetous fermentation. The acid thus 
generated is neutralized by the alkali, and the chy- 
lification of the food best promoted by this artificial 
substitute for bile. 

It seems not improbable, that bilious colic is of- 
ten the result of an acid fermentation in the chyme, 
which proceeds from deficient or obstructed excre- 
tion of bile. The spasm induced by the acid at. 
such times and the painful distention by flatus are 



BILIARY CONCRETIONS. 153 

almost immediately relieved by drinking an alkaline 
solution proportional in strength to the quantity of 
acid in the stomach and intestines. The severe 
colic often induced by having taken into the stom- 
ach too much acid fruit and its sudden disappear- 
ance upon administering an alkaline remedy, strong- 
ly corroborates the opinion just now advanced. At 
the same time the patient takes his alkaline reme- 
dies, he should make free use of cordial diluent 
drinks, for water is the bond of union between the 
alkali and the component principles of the gall- 
stone, and is the natural solvent for hardened soap. 
Corpora non agunt, nisi soluta, was the practical 
maxim ever kept in view by the ancient alchymist ; 
and that two bodies can have no chemical action upon 
each other , unless one of them be dissolved, is a law, 
held equally sacred by the modern chemist. 

Besides some biliary calculi are said to be solu- 
ble in water, while others are not. " Aliqui in 
aqua* solvuntur, non quidem omnes."(p) 

The vegetable or mineral alkali should be ad- 
ministered in small doses at first, and increased as 
the stomach can bear them. 

The soda is very conveniently administered and 
readily taken in the water of the supercarbonate of 
soda of the Dispensatory. 

' Hauler's Phy,$iologia, vol. vi. p. 575, 






154 A DISSERTATION ON 

In Townsend's Guide to Health, p. 469, mention 
is made of ammonia being given in the dose of one 
scruple in mint- water three times a day for the cure 
of jaundice from the presence of biliary calculi in 
one of the bile-ducts. The tartarized kali is like- 
wise there highly recommended as a remedy for the 
same disease originating from the same source. It 
Is recommended in the dose from a scruple to a 
drachm three times a day either alone or combined 
with rhubarb. 

Dr. Darwin, from the circumstance of having 
dissolved a gall-stone in sulphuric ether, suggests the 
propriety of combining the ether and yolk of art 
C £E> to be taken by the jaundiced from biliary calculi. 

Ether combined with the white of an egg, says 
M. Fourcroy, at the same time it dissolves the cal- 
culi, is very useful in allaying the spasm and con- 
traction, which they produce in the gall-bladder. 

Though the above chemical remedies may be 
proper in the cure of biliary concretion in cases where 
all the symptoms are moderate ; in cases where the 
symptoms are severe, they are too tardy in the ope- 
ration to be employed with any sanguine hopes of 
affording immediate relief. 

III. Chemico-mechanical remedies are formed by 
the union of those medicines which stimulate the 



BILIARY CONCRETIONS. 155 

fibre to contraction and of those which act chemically 
from the established laws of affinity. The different 
indications to be answered in the cure of biliary 
concretion seem to point out this compound remedy* 
The gall-stone is not only to be dissolved, but the 
stomach and intestines are to be stimulated from 
their quiescent, torpid state to a more vigorous per- 
formance of their accustomed functions. To effect 
both of these indications, the alkali, whether vegeta- 
ble or mineral, may be combined with some gently 
stimulating substance to increase the peristaltic mo- 
tion of the intestines, and render their actions more 
equable and vigorous. Soda and the white-pine 
turpentine, soda and rad. rhei, or potass with either 
of the above articles, may answer a valuable pur- 
pose in procuring this compound effect. 

In cases of dyspepsia attended with slight symp- 
toms of jaundice, I have seen pills, a compound of 
equal parts of white-pine turpentine and soda, ad- 
ministered with the most satisfactory success. The 
number of pills taken at a time should be increased, 
until they render the bowels moderately relaxed. 
Other cathartics may answer equally well, provided 
they do not stimulate the bowels to such a degree as 
to cause the alkali to run off by stool before it can 
be -absorbed by the lacteals, and provided no action 
take place between the alkali and the cathartic 
medicine used. The metalic salts would not an- 
swer, for the affinities between the acids and the a!- 



156 A DISSERTATION ON 

kalies arc stronger than between the acids and the 
metals. After the chemical solution of the gall- 
stone, or its expulsion through the ductus com- 
munis choledochus into the duodenum undissolved, 
tonics and a rigid attention to the non naturals will 
generally restore the patient to his accustomed 
health and prevent a return of his disease. 

In some rare instances, nature seeks relief from 
the irritations of gall-stones in quite a different way 
from those previously pointed out. 

An adhesive inflammation is first excited, which 
attaches the gall-bladder to the parietes of the 
abdomen. Ulceration commences, and an hepat- 
ic abscess is formed. The ulcerative inflamma- 
tion progresses, dissolving and absorbing the 
external surrounding soft parts, until an outlet is 
made for discharging the purulent matter and the 
gall-stones through the skin. As a more correct 
account of this mode, sometimes pursued by nature 
in the cure of biliary concretion, cannot be found, 
than that, which is contained in the * writings of 
the celebrated Albert Haller, the reader is presented 
with the following, which is a translation from the 
original Latin of that author. 

Nor are the cases rare, where biliary calculi have 
been discharged with very considerable pain from 

* Haller's Physiologia, vol. vi. p. 595— 6, 



BILIARY CONCRETIONS. 157 

an open ulcer in the side. These calculi have been 
voided from a tumour in the umbilicus. This is 
noticed by many writers. The gall-bladder has be- 
come, after adhering to the abdomen, a small foun- 
tain, from which has distilled a yellow lymph. 

After the excretion of the bile, the gall-bladder 
has adhered, filled with calculi, which have remained 
without any bile. The gall-stones have burst through 
the teguments of the abdomen, and passed out at the 
side — Through a broken abscess of the abdomen 
angular gall-stones have passed out — There is first 
a scirrhus of the right side, and afterwards a sponta- 
neous rupture of the gall-bladder. Bile then flows 
out. At intervals there are fistulous openings, 
which alternately close and open — There have 
been abscesses of the epigastrium, through which 
numerous biliary calculi have been seen to pass. 
Chesselden mentions calculi, which have spontane- 
ously opened to themselves a passage, and others 
which have been cut out, where the patients have 
afterwards recovered. J. Lud. Petit, who followed 
nature in the practice of surgery, has merited much 
for curing a patient afflicted with this dreadful mala- 
dy. From the site and fluctuation of the tumour, 
which was circumscribed and adhered to the tegu- 
ments, he conceived the necessity of making an incis- 
ion into the gall-bladder. Nor did he timorously de- 
sert his patient, without daring to test the correctness 
of this novel opinion. Afterwards he made a very 



158 DISSERTATION ON BILIARY CONCRETIONS. 

small opening into the gall-bladder, which he en* 
larged by introducing a style, and at length took 
out a gall-stone, which effected the cure. The op- 
eration has lately been performed by other eminent 
surgeons, particularly by J. Zacharias VogeL 

Heberden mentions a case, * which terminated 
favourably, The following is his account of it. 

u A woman, fifty years of age, was for ten days 
severely afflicted with pain of the stomach, hiccough, 
purging, and faintings, and with difficulty struggled 
through it. A month after there arose a swelling 
near the navel, which was opened, and discharged a 
great quantit}^ of yellow fluid for the space of four 
years ; at length the pain increased, together with 
sickness and shivering, and after a few days there 
was discharged a gall-stone three inches long and as 
much in circumference, weighing 245 grains. Dur- 
ing the two following weeks a thin liquor was 
poured out in great abundance ; soon after the sore 
healed up and the woman recovered. It is evident 
the gall-bladder must in this case have inflamed and 
suppurated." 

* Commentaries on the History and Cu*e of Diseases* p. 252 



NOTES. 



NOTE (A) 

X HERE is no subject at present more interesting to the 
inquisitive physiologist, than cutaneous absorption. The 
Philadelphia Lyceum have felt such a concern in ascertaining 
the fact) that the society offered a reward last winter to any 
one who would demonstrate it. Lord Verulam's mode of 

investigating physical science by experiments has become so 
fashionable among the faculty, that the medical mind can 
now rest satisfied with nothing but demonstration. The 
whole evidence however in favour of cutaneous absorption 3 
when embodied, amounts to probability. If the following, 
which are transcribed from the writings of Baron Haller, 
(Physiologia. vol. v. p. 90) can be admitted as facts, the prin- 
ciple contended for must be considered, as already settled 
upon the solid basis of certainty. 

Ex Gatinaria puella quotidie per 60. dies pocula min- 
xit 16. qualia tria biberat, ut in eo tempore, 1740. libris 
urina superaret, & super cibum potumque, amiserit Moras 
1740. felici tamen cventn. Many other similar instances 
are quoted by the same author, who thus comments upon 
kis quotations. 

In his exemplis, cum plus urinse reddatur, quam cibus 
potusque possint reparare, & cum ipsum corpus paucos ad 



160 

dies tantae jacturse sufficeret, etiam sitotum in aquas difnueret^ 
creditum est, ab aere omnino humorem resorberi. Respira- 
tione sola absorberi non posse tantum aquae, calculis positfc 
C. Taglini reperit 



NOTE (B) 

The rete mucosum not unfrequently undergoes a material 
change of colour in the same individual, after he has attained 
to years of manhood. Every one must have noticed the 
great change of complexion, which takes place in the conver- 
sion of the " sweet-scented beau 9 " into the hardy tar. 
Likewise the African complexion may be bleached by com- 
pression, or by any stimuli, which shall act powerfully upon 
the cutaneous absorbents : hence the negro is white in the 
palms of his hands and upon the soles of his feet, which are 
much exposed to mechanical compression. The vapours of 
the oxigenated muriatic acid likewise bleach his complexion. 

In the American Philosophical Transactions (vol. iv. p. 
295), Dr. Rush has communicated the following extraordina- 
ry physiological fact respecting a change in the colour of the 

rete mucosum. 

"Ina certain Henry Moss, who lately travelled to this 
city (Philadelphia), the change from a black to a natural 
■white flesh colour began about five years ago at the ends of 
his fingers, and has extended gradually over the greatest part 
of his body. The wool, which formerly perforated the cuti- 
cle has been changed into hair. No change in the diet, drinks, 
dress, employment, or situation of this man had taken place 
previously to this change in the skin,' , Many other similar 
instances are upon record. 



161 

NOTE (C) 
That the Jews and Christians are not the only people, into 
whose religious creeds has been introduced a belief in the 
sameness of original, among our species, is proved by the 
following, which is an extract from Asiatic Researches, 
vol. vi. p. 253. 

tc It being admitted, that all mankind are the offspring of 
"the same stock, namely, of the Biamma, who descended from 
cc the abodes of Rupa; a certain Burma doctor asks, why there 
" is not the same language among all nations ; and whence arises 
(( that variety of manners, religions, complexions, and features 
cc so observable among the inhabitants of this earth ? This same 
<c doctor thinks he answers the question by saying, that the 
u first inhabitants of the world after having greatly multiplied 
Ci by marriage were forced to emigrate into various parts of the 
a earth ; and as in these the climate, air, water, natural pro- 
"ductions, &ndte?nperature are extremely different, such cir- 
cc cumstances could not have failed to produce an effect on the 
Ci manners, religion, and appearance of those who were under 
u their influence. For if in one kingdom the inhabitants vary 
$f in stature and colour, how much more evident must this dif- 
ference be amongst the inhabitants of remote countries?'" 

AU the varieties in the human complexion are readily ac- 
counted for by the varieties of climate and habits of life ? 
which are the physical agents that diveisify the colour of 
man. Change of feature as great may be produced by the 
absurd customs, which obtain among the human race. The 
Chinese damsel, whose pride is the smallness of her foot, and 
the Ethiopian, who glories in his bandy legs, thick lips, fiat 
nose, arched forehead, andglossy 3 smooth and jet-black skin, in 
some measure regulate the operation of those physical causes, 
which are concerned in the production of these l( fancied 
beauties.' 1 ' The depraved taste, upon which these singular 



162 

preferences are grounded, cannot be more unaccountable, 
than that which led the officers in the court of Alexander the 
Great, to wish they might each of them have fistula in ano< 
in humble imitation of the Great Emperor. 

What was originally casual, eventually becomes constitu. 
tional ; and what a series of centuries has been concerned in 
accomplishing, cannot be expected to be obviated within a pe- 
riod short of the original term, consumed in its accomplish- 
ment. In the island of Jamaica there is a law of enfran- 
chisement, which invests the fifth in the order of descent from 
an African, with all the rights, immunities, and privileges of 
the native white. 

■ 

In Edward's History of the West-Indies, vol. ii. p. 19. 
is the following account of the different gradations of people 
according to their complexion in Jamaica. 

iC Among the tribes which are derived from an intermixture 
iC of the whites with the negroes, the first are the mulattoes ; 
"next to these are the tercerones, with some approximation 
u to the former, but not so near as to obliterate their origin. 
a After these follow the quarter ones ^ proceeding from a 
a white and a terceron. The last are the quinterons, who 
iC owe their origin to a white and a quarteron. This is the last 
" gradation, there being no visible difference between them 
a and the whites, either in colour or features ;. nay, they are 
a often fairer than the Spaniards. The children of a white 
44 and quinteron consider themselves as free from all taint of 
a the negro race." 

The principle admitted that the refinements of civilization 
will obliterate one sixteenth of the African complexion in five 
generations, and the generation in a West-India climate being 
limited to fifteen years, seventy-five years would be consumed 



163 

in bleaching asixteenth part of the African complexion. Ac« 
cording to this calculation twelve centuries would elapse, 
before the habits of civilization would change the jet-black of 
the African to the dark brown of the native West-Indian, 
who could regularly trace out his descent from ancestors, Eu- 
ropean-born. It is probable, that a considerable longer term 
of time would be requisite to produce the desired change of 
features. Compression, which was the most probable original 
cause of the flat nose, could not be made to operate in restor- 
ing to it its original shape. 

King Solomon's analogy between man and beast,* the 
story of Jacob's getting the ownership of all the stronger of 
the cattle in Laban's flocks, -fand the account of the increased 
ratio of black lambs, when their white dams are put into i\ew 
pastures, where they blacken their fleeces by rubbing against 
logs partially burned, might be here enlarged upon, to shew 
that casualty may sometimes be concerned in darkening even 
the human skin. 

For the various arguments in favour and against the 
ness of original among our species, the reader is referred 
Essay on the Causes of the variety of complexion and 
in the human species, by Rev. Samuel Stanhope Smith, x>. D. 
and to Lord Kaim on Man. 



NOTE (D) I 

No law of the animal economy is more familiar, than the 
sighing produced by the accidental plunge of the foot into 
cold water, or the sprinkling of that fluid at a reduced tem- 
perature upon any portion of theskin. The sympathies be. 
tween the skin and the rest of the system render a knowledge 

* Ecclesiastes, chap. iii. f Genesis, chop, xxx 



164 

6* its functions exceedingly important, not onty in the treat* 
ment of disease, but also in restoring suspended animation. If 
animal temperature be at the proper standard, no remedy 
perhaps is so certain in its operation in restoring suspended res- 
piration, or indeed, suspended animation, as the external ap- 
plication of cold to the naked skin. Of course, cool air, cold 
water, ice, snow, &c. are common external applications to the 
skin, not only in the restoration of suspended animation in new- 
ly born infants, but likewise in the resuscitation of those ap- 
parently destroyed by lightning or by respiring the carbonic 
acid gas. In re-exciting suspended animation, the cold acts 
the same part, which it performed at first in originating respi- 
ration. A distinction is however to be made between the dif- 
ferent ways of producing cold in the two cases. In the first 
instance, the cold is produced by evaporation from the surface 
of the body, for the infant breathes whether it be immersed in 
an atmosphere at a reduced, or at a temperature elevated 
above that of the body. In the second instance, the sub- 
stance to be applied to the skin must be at a temperature, re- 
duced below that of the animal, because the functions of the 
iVm are s-aspended in their exercise, and therefore cannot pro- 
duce cold hy evaporating the perspirable matter. 



NOTE (E) 
In Asiatic Researches, vol. v. p. 345 and following, are 
to be found very particular injunctions respecting personal 
cleanliness, interwoven among the religious rites of the Hindus. 

u A Brahman, rising from sleep, is enjoined under the 
i6 penalty of losing the benefit of all rights enjoyed by him, to 
4 rub his teeth with a proper withe, or a twig of the raraecife- 
H rous figtree 5 pronouncing to himself this prayer : 



165 



"Attend, lord of the forest; Soma, king of herbs and 
" plants, has approached thee ; mayest thou and he cleanse 
"my mouth with glory and good auspices, that I may eat 
" abundant food, &c. The following prayer is also used up- 
" on this occasion : Lord of the forest ! grant me life, 
" strength, glory, splendour, offspring, cattle, abundant 
"wealth, virtue, knowledge, and intelligence. 

" But if a proper withe cannot be found, or on certain 
66 days when its use is forbidden (that is on the day of the 
w conjunction ; and on the first, sixth, and ninth days of each 
" lunar fortnight,) he must rinse his mouth twelve times with 
" water. 

" Having carefully thrown away the twig, which has been 
" used in a place free from impurities, he should proceed to 
" bathe, standing in a river, or in other water. The duty of 
" bathing in the morning, and at noon if the man be a house- 
" holder, and in the evening also, if he belong to an order of 
" devotion, is inculcated by pronouncing the strict observance 
" of it as no less efficacious, than a rigid penance in expiating 
"sins, especially the early bath in the months of Magna, 
" Pholgima, and Cartica : and the bath being particularly 
" enjoined as a salutary ablution, he is permitted to bathe in 
" his own house, but without prayers, if the weather or his 
" own infirmities prevent his going forth ; or he may abridge 
" the ceremonies and use fewer prayers, if a religious duty or 
" urgent business require his early attendance. The regular 
" bath consists of ablutions followed by worship, and by the 
" inaudible recitation of the Gayatri with the names of the 
"worlds. First sipping water, and sprinkling some before 
"him, the priest recites the three subjoined prayers, while he 
" performs an ablution by throwing water eight times on his 
" head, or towards the sky, and concludes it by casting water 



166 

u . on the ground to destroy the demons, who wage war wita 
" the gods. 

" 1st. O waters ! since ye afford delight, grant us present 
" happiness, and the rapturous sight of the supreme God. 
"2nd. Like tender mothers make us here partakers of your 
" most auspicious essence. 3d. We became contented with 
" your essence, with which ye satisfy the universe. Waters ! 
" grant it unto us. For, as otherwise expounded, the third 
" text may signify, Eagerly do we approach your essence, 
" which supports the universal abode. Waters ! grant it 
" unto us." 

In further proof of the importance of water and of ablu- 
tions, in the estimation of the Hindu, to his spiritual salva- 
tion, the following is quoted from the same volume, p. 354. 

"I offer this water to the sun, whose light irradiates my 
" heart, who sprung from the immortal Essence. Be this ob- 
"lation efficacious — as he who bathes is cleansed from all 
" foulness — so may this water purify me from sin. The ab^ 
" lution is finished by the following prayer. 

" Water ! thou dost penetrate all beings ; thou dost reach 
" the deep recesses of the mountains ; thou art the mouth of 
" the universe; thou art sacrifice; thou art the mystic word 
ci vasha; thou art light, taste, and the immortal fluid. 

" Preparatory to any act of religion, ablution must again 
'"be performed in the form prescribed for the mid-day bath ; 
" the practice of bathing at noon is likewise enjoined as requi- 
" site to cleanliness, conducive to health, and efficacious in re- 
" moving spiritual as well as corporeal defilements. 

" If there be no impediment, he may bathe with water 
" drawn from a well, from a fountain, or from a bason of a 



167 

ii cataract ! but he should prefer water, which lies above 
Aground, choosing a stream rather than stagnant water; a 
66 river in preference to a small brook ; a holy stream before a 
i: vulgar river, and above all the water of the Ganges — 

66 After bathing and cleaning his person, and pronounc- 
K ing as a vow, I will now perform ablutions, he who 
u bathes should invoke the holy river ; O Ganga, Yamuna^ 
*" Satadr-U) Marudviaha, Jiyiciya ! hear my prayers; for 
"my sake be included in this small quantity of water with 
: -the holy streams of Parushti, Asieni, and Vitasta — what- 
iC ever sin has been committed by me, do thou, who art up- 
ci held by the hundred armed Crishna, ascend my limbs ^ and 
:i remove every sin " 

The priest recites the following accompanied with many 
ciystical flourishes. 

" Waters I remove this sin, whatever it be, which is in me ; 
*' whether I have done any thing malicious towards others, or 
i( cursed them in my heart, or spoken falsehoods. 2nd. Wa. 
u ters! mothers of worlds! purify, us ; cleanse us by the 
iC sprinkled fluid, ye who purify through libations ; for 
a ye, divine waters, do purify every sin. 

a May divine waters be auspicious to us for acctimula, 
;i tion, for gain, and for refreshing draughts : may they lis- 
iS ten to us, that we may be associated with good auspices. 
6i Next reciting the following prayer, the priest should thrice 
•'plunge into water: O consummation of solemn of rites ! 
M who dost purify, when performed by the most grievous of- 
u fenders ; thou dostin vite the basest criminals" (the most 
slovenly villains) "to purification; thou dost expiate the 
cc most heinous crimes. 



168 

iC One who lias drunken spirituous liquors, should traverse 
ci water up to the throat, drink as much expressed juice of the 
u moon-plant, as he can take up in the hollow of both hands, 
4 • while he meditates the triliteral monosyllable, and then 
" plunge into water, reciting, 

u May the waters free me from every defilement^ whatever 
u be my undeanness J' fyc. fyc. 

If the civilised christian, from the prudential considera- 
tions of self-preservation, would make the same liberal use of 
water by daily ablutions, as the half-savage pagan makes, from 
the religious considerations of washing away his own spiritual 
defilements, a great many of the obstinate cutaneous as well as 
general diseases, which now afflict mankind, might not only 
be prevented, but cured without the administration of any 
other remedy. Pinckard, in his Notes on the West Indies, 
(vol. ii. p. 149 and 150) gives an account of the practice 
of bathing among the negroes of Barbadoes, which is not dis. 
similar to the preceding accounts of the Hindu worship. 

u A sense of cleanliness attaches to their love of the water, 
4 < for we not only see them often in the sea, but frequently 
a also washing themselves in rivulets. It seems to form one 
6i of their favorite amusements to stand in the sea, or river, 
u and to take up water in both hands, aud pour it over their 
" shoulders down their backs. This is practised both by the 
iC men and the women, and is one of their most frequent methods 
" of bathing. Another mark of cleanliness also prevails 
iC among them, which was less to be expected ; viz. that of 
Spaying great attention to their teeth. The chew-stick, 
* c which is here employed for cleaning the teeth, is far more in 
H use among the negroes, than the tooth-brush among the 
66 lower classes of people in England. Our adroit negro, 
u amidst his many gambols in the water, dived to the bottom 



169 

tc of the sea, and brought up a handful of sand. With this 
u rough dentifrice he soundly scrubbed his teeth, and by way 
<c of essence to wash it off, plunged down to the bottom for 
iC another handful with his mouth wide open ; thus alternately 
<i repeating the rubbing and sea-water washing until he felt 
"his pearls were duly contrasted with his ebon countenance." 

In further proof of the importance of perfect cleanliness of 
the skin in procuring its exemption from disease, the following 
is extracted from Jackson's Dermato-Pathologia, p. 152. 

"When I minutely consider the uses and impor|g,nce of 
u the cutis vera^ and all its appendages in the animal economy, 
li and their connexion, directly or indirectly, with all the prin- 
66 cipal functions of animal life, or the sensitive principle, I am 
iC very much inclined to think with Mr. Howard, that the 
a want of necessary attention in parents and others, who have 
cc the care of young children, to the outer surface of their ten- 
a der and growing frames, by constant cleanliness and sufficient 
iC ablution, too certainly dries up, weakens, or impoverishes, 
" while they are in their infancy, that spring of health, a 
c( sound and perfect skin, and which eventually deprives them 
u of the full strength of manhood, when they reach that period 
cc of life, and to which they may have been hereditarily enti- 
a tied. I believe, that if such prophylactic means, as cold 
" washing, and cold bathing, were from their birth unu 
" versa! ly attended to, in their full extent, we should soon 
" lessen the number of diseases." 



NOTE (F) 

The first appearances of the Jewish leprosy answer to those 
of the British, as described by the discriminating Willan, ia 
his elaborate treatise On Cutaneous Diseases, p. 112. 

X 



170 

6i Lepra Vulgaris exhibits first small, distinct elevations of 
^cuticle" (a rising,) " which are reddish and shining, but 
(i never contain any fluid. On their surface, when examined 
u through a magnifier, the cuticular lines are found obliterat- 
"ed : and within a few hours, a thin, white scale" (a scab) 
ic is formed on the top of each of them. In three or four days 
Ci the small elevations appear flattened, and are at the same 
6< time dilated by an extension of their bases to the size of a 
4i silver penny. These patches continue to enlarge gradually, 
a till they nearly equal the dimensions of a crown piece. 
u They have always an orbicular or oval form; are covered 
" with^ry scales, and surrounded by a red border," a bright 
spot. 

The subsequent symptoms of the Jewish leprosy seem not 
very well to agree with those in the leprosy of Britain ; f o 
the leprosy here pointed out by the Jewish law-giver was 
spontaneously cured by the powers of the constitution ; at 
least, no mention is made of the use of any remedies. Willan 
observes, that the modern leprosy of Britain is not cured, 
without medical assistance. 

Dr. Joseph Adams, On Morbid Poisons, p. 205, supposes 
this disease, which Moses has called plague of leprosy , to have 
been no other than yaws. The opinion seems not to be with- 
out foundation. 



NOTE (G) 

" A simple warm bath, along with moderate friction, like- 
" wise contributes to remove the scabs and to produce a soft 
ci red skin, which, in time, regains the usual colour and 
u texture. This plan is sufficient in the slighter cases of lepra, 
li without the use of any internal remedies. If the disease 



171 

u affect the extremities only, bathing of the whole body is 
" not necessary ; it may be enough to apply steam, or warm 
" water, frequently to the disordered parts." 

P. 146. The following is copied from an Essay on Dulcsu 
niara, by Mos. Carrere, in the cure of Lepra. 

u The true lepra is the only disease of the skin, in which 
ci I would venture to assert the dulcamara will generally effect 
(i a cure. Out of twenty-three cases of lepra Grsecorum, in 
a which I have tried it, two only have resisted its action. 
u All the others were completely cured. I exhibit the dulca- 
" mara as follows : 

" R. Stipitum Dulcamarae imciami. Aquae purae libram 
" i. ss. : decoque ad libram i. ; & liquorem frigefactum cola. 

cc Of this decoction I generally desire the patient to take 
" two ounces every morning, noon, and evening ; but I after. 
" wards increase the quantity until the pint is consumed every 
ct day. At the same time I order the patient to wash the skin 
u with a stronger decoction, which greatly accelerates the 
cc cure. The remedy seldom begins to exhibit' any evident 
ci good effects for the first eight days." 

" None of the above remedies are applicable for the cure 
u of lepra nigricans. This form of the disease requires, in 
" the first place, a regular and nutritive plan of diet, with 
u moderate exercise : it may be afterwards wholly removed 
" by the use of bark, and the mineral acids, sea-bathing, &c."* 

Having never seen any well marked cases of leprosy 
(they being exceedingly rare in this country) I wrote to Dr. 

* WUlan on Cutaneous Diseases, p. 147. 



172 

Haskell of Worcester county, a physician of much attend re 
observation and great experience, who very politely commu- 
nicated to me the following, which is transcribed in his own 
words. 

A CASE OF LEPROSY. 
" The stale of the patient when 1 was first consulted^ Dec* 6th 3 

1782. 

"Miss B. J. of L. aged 13, of a delicate constitution and 
" sprightly disposition, was completely covered from head to 
" foot with a dry, scaly or crusty eruption : except the middle 
" of her forehead, her nose, round her mouth to the end of her 
" chin, and the backs of her hands and feet, which were af- 
" fected in a less degree ; except also the insides of her hands, 
"and the bottoms of her feet, which were not affected at all. 
" In the bend of her elbows and hams, the skin was so corru« 
"gated, that in attempting to extend them the skin was actu~ 
* Q ally fissured with some aiFusion of blood. The crusts, which 
" were thick and prominent, were of a yellowish and brownish 
"cast, mixed with white ; but the parts covered with thin 
" scales exhibited a whitish appearance. Between the scales or 
" crusts, and under them, when scratched off, the skin appeared 
" preternaturally red and inflamed. And the whole surface 
" of her body exhibited some degree of oedema or bloated ap- 
" pearance. And she experienced an uneasy sensation, which 
"she said was not like that of a common itching, but rather a 
" prickling, resembling that of being raked with a card ; and 
"this was especially troublesome when warm in bed, inducing 
"at those times an almost constant scratching : hence she usu- 
" ally left a handful of scales in bed after her, every morning. 

" Her general health did not appear to be very materially 
" affected ; as her appetite for food and drink, and her excre- 
"tious by stool and urine, were nearly in their natural state. 
" Jn my notes J did not notice the state of her pulse. Her 



173 

" spirits were rather low and dejected, and there were marks 
a of a considerable degree of general debility. 

Ci Preliminary information obtained from the patient and her 

mother. 

iC About three years ago, (from the date above,) there 
" came out a spot on each arm, which began like a tetter, in- 
a creased to the size of a copper, was covered with white scales, 
:i continued a while, and then disappeared spontaneously, 
i£ leaving the skin smooth and of a whitish cast, which appear- 
66 ance it retained, till the approach of her present disorder, 
Ci which her mother dates about a year ago. At this last men- 
tioned time another spot appeared on her arm, resembling 
w the sting of some poisonous insect, which itched to such a 
:i degree, that her mother suspected it to be the itch. It rose 
u above the level of the skin, and upon being scratched, dis- 
Ci charged a little watery fluid, felt hard under the skin, and 
u soon became covered with a white scurf, which gradually 
a increased in breadth and thickness to the size of a copper. 
" About the same time similar appearances occurred in several 
** places on her head. And from this time forth it went on 
<c increasing, by making its appearance in other new places, 
"till it overspread the whole surface of her body, as above 
u described, and became the most universal leprosy I ever 
" witnessed. 

" Methodus Medendi, Dec. 6th, 1782. 

u She had hitherto been under the care of Dr. J. t). who 
" prescribed many medicaments to me unknown, under whose 
a operation she found no relief, but, on the contrary, her dis- 
u order appeared to be gaining ground fast upon her. This 
u information, however, respecting her treatment I received 
a from her mother, that the only external application used was 
u friction with a cloth fumigated over burning sulphur. 



174 

" R Sulphurcti antimonii prascipitati drachmas duas ; Hy« 
"drargyri drachmam unam : sinml triturentur, & fiant Pulvis 
" iEthiopicus. Hujus Pulveris capiat iEgra Grana triaonmi 
"Nocte, hora Decubitus. 

" Be Sulphatis sodae drachmas sex (in aquae callidae unciis 
"sex soluti) secundo quoque inatutino, ad tres vices. 

" December 16th. The symptoms nearly the same. The 
" powders occasioned some nausea ; but the sulphate oper- 
" ated well. The gums and glands of the throat a little swell- 
ed ; but no ptyalisin* 

" R Sulphuris sublimati, & super-tartritis potassae sin. 
" gulorum Unciam unam ; Nitratis Potassae semunciam : fiant 
" Pulvis, dequo capiat omni nocte Drachmam unam. 

"Repetatur quoque sulphatis sodas dosis eadem, bis in 
" septimana. Partes affectae etiam, mane & vesperi Panno sul- 
u phure urente fumigato ? fricentur. 

" December 23d. The friction seems to produce a more 
" agreeable sensation in the skin for a short space; but the 
" disorder appears in no degree mitigated. 

' " Continuenter Pulvis iEthiopicus & Pulvis Sulphureus, 
" alternis vicibus omni nocte ; et Catharticumut antea repe- 
" tatur. Totum corpus a capite ad pedem decocto callido 
" e Lapatho, Verbasco, & Malva omni nocte lavetur. 

" January 1st, 1783. The symptoms nearly the same. 
a The lotion renders the skin more soft and pliant, than the 
"dry friction, and in some degree diminishes the troublesome 
"itching. 



175 



ii Continuentur medicamenta ut antea. Sed post singulam 
^lotionem, partes circum articulors, genua & cubitos 
a praecipue, Unguento Resinas Empyreumatica? Pini sylvestris 
"illinentur. 



a January 8th. The disorder on the decline ; the skin 
6i round her elbows and knees becoming much more pliant, 
iC the crusts having fallen off. 

cc Continuentur medicamenta : sed applicetur Unguentum 
** omnibus Partibus maxime affectis. 

u January 16th. The disorder gives way fast, the skin in 
u many places appearing natural and smooth. 

u Medicamenta omnia continuentur. 

" SEQUEL. 

u By persevering in this course she soon became to appear- 
u ance perfectly well and sound. She has however since that 
" time had several slight attacks of the same affection ; but 
u by having recourse to the above mentioned iEthiopic pow- 
u der, salts, and unguent, and several times by the use of the 
ci unguent alone, it was soon removed, and indeed with very 
" little trouble. 

« OBSERVATIONS. 
Ci The above w T as the first case of the kind to any consider- 
w able degree that occurred in my practice. And it is easy to 
" be perceived, that I had not then shook off the trammels im- 
a posed by ancient maxims. The doctrine of a humoral pa- 
iC thology pointing to a cachochymia as a cause, and the famous 
" Vis Medicatrix Naturae, ever vigilant to guard the nobler 
*' parts, and active in throwing the acrimony off from them to 
4i the surface^ where it could do the least mischief, seem to be 



176 



" among the leading doctrines of the ancients, respecting the 
" disease now under consideration. And these doctrines nat* 
" urally suggested the propriety of trusting the cure princi- 
" pally to internal remedies ; and at the same time imposed 
" a strong caveat respecting external applications. And the 
" practice thus founded almost reduced leprosy to the class of 
"incurables; for instead of curing the patient, it proved a 
"lasting opprobrium to the medical art, and laid the foun- 
" dation for the introduction and increase of quackery. For 
"the unfortunate patient, tired out and disgusted by a long 
"continuance of swallowing nauseous doses, and dishearten- 
" ed and dejected by finding little or no relief from them, 
"as if in a fit of desperation, flies to some unprincipled 
"quack, who, equally regardless both of the principles of mo. 
"rality, and these erroneous maxims, draws a bow at a ven- 
ture, and chances to hit upon something that cures his pa- 
" tient. This guess-work tears the laurel from the brow of 
" the noble profession, and fixes it upon that of ignorance 
" and quackery. For I am persuaded that it is owing to er- 
" rors like these, that quackery has maintained its sway over so 
" large a proportion of mankind to the present day. And so 
"long as such errors are retained and practised upon; so 
" long will every effort to expose the baseness and absurdity 
" of quackery be construed into selfishness and illiberality. 
" Ignorance will hold up its brazen head, and the presuming 
" pretender thus supported, will deride every attempt to ex- 
" pose his ignorance. 

" In continuation of the ancient doctrine of assigning a 
" cachochymia for the remote or predisposing cause of leprosy, 
"a sedentary and inactive life, together with gross feeding, 
" especially living much upon swine's flesh and fish, have been 
" charged with being the cause of introducing that depraved 
"state of the humours. But these could not operate as a 
"cause of this patient's complaint, for her parents say, she 



177 

" was always sprightly, and lived an active life, and never craved 
" either flesh or fish, but always preferred a milk and vegetable 
"diet. On the whole I could assign no particular errors in 
" the non-naturals, as the cause of this patient's disorder. 
" Perhaps a peculiar state of the skin is the predisposing cause ? 
" giving effect to the action of the air upon it, at certain sea- 
sons, or in particular states of the atmosphere. For I have 
"obsetved leprous affections to rage most 3 and be most preva- 
" lent in the autumn and spring. 

" Therefore however repugnant to the ancient doctrine, or 
" however singular 01 erroneous the sentiment may appear, I 
" am induced to believe, for many reasons founded on obser- 
" vation, that leprosy is a local affection, whose seat is thesub- 
*' cutaneous glands and their excretory ducts. These being af- 
u fected by inflammation, are thrown into morbid action, and 
" consequently secrete and excrete an increased quantity of 
" vitiated fluid, which being too gross to escape through the 
"fine pores of the epidermis, raises the scarf skin in the 
" form of serpiginous eruptions ; and being likewise too viscid 
"wholly to evaporate and fly ofF in the form of insensible 
"perspiration ; but drying on the surface forms those white 
" scales or scurf, which are the distinguishing mark of leprous 
" affections. Whilst at the same time the inflammatory af- 
" fection of the cutaneous vessels raises the part affected a lit- 
" tie above the common level of the surface, and presents to 
" the touch the sensation of hardness in the prominent parts, 
"and which also, when the affection is general over the sur- 
" face, occasions some degree of bloated appearance. 

"In regard to the cure of leprosy, I am constrained to 
"say, that I never knew a cure effected by internal remedies 
" alone, or where it could be fairly ascribed principally to 
" their use. In the case before us the patient had been long 
" subjected to a course of internal remedies before I saw her« y 

y 
I 



178 

u biitto no effect. And after she came under my care the ie- 
"fluenceof the ancient doctrine induced me to push them 
" to a much greater extent than I now deem necessary ; not- 
6i withstanding which, I gained no ground of the disorder, 
4i till the warm ablution and unguent were made use of. 

iC I was lately called upon to visit a very respectable lady, 
u who laboured under the severest crural elephantiasis* I 
iC . ever saw, (and I have seen several), and who had beentreat- 
u ed by a course of mercurials, till her strength was greatly 
w reduced, a copious ptyalism brought on, and a sore mouth, 
" produced to a degree which totally disenabled her from tak- 
"ing any kind of solid food for more than a month, though 
"her appetite sufficiently craved it; yet under this severe 
66 treatment her disorder in no degree gave way, but rather in- 
a creased. But being put upon a course of bark as a tonic, 
44 sublimed sulphur, and supertartrite of potass, with one or 
u two of the gentlest cathartics, as antisialagogues, and slip. 
u pery elm tea, as a demulcent ; and at the same time wash- 
a ing the part daily with warm milk and water, and some- 
cc times wfth hard-soapsuds, and applying after each wash- 
a ing an unguent composed of four parts of ung. resin, empy- 
6i reumat. pin. sylvestr. and one part of ung. nitrat. hydrarg- 
a yr. her disorder gave way, and she gradually recovered. 

I 

66 Instead of the above topics, I have frequently applied a 

u weak solution of the muriate of quicksilver, and the simple 

, a tar ointment after it, and with equal success. Nor do I 

u suppose these to possess any specific virtues, by which 

" they effect a cure in some unaccountable manner. In ev- 

* Tliis elephantiasis must have been a disorder very different from 
the elephantiasis of warm climates. D. H's. account of it, by no means 
corresponds to that which in Barbadoes is called the " Glandular Dis- 
ease." However this may be, it is of very little consequence ; ftirsymp- 
toons, and not navies, claim the attention of the philosophic physician 



179 

" ery prescription of this kind the object is, I conceive, to 
"arrest the morbid action of the vessels, which pour out an 
"increased quantity of vitiated matter upon the surface, 
" where this same morbid secretion continues the tragic scene> 
44 by raising the inflammation higher, and spreading it wider ? 
"and thus producing and increasing the exulcerations ; and 
" at the same time to restore the action of the absorbents, and 
" heal those exulcerations. And what is better calculated 
" to answer those intentions than remedies .possessing in a cer- 
" tain degree an escharotic quality, (such as the oxides, thcni- 
" trate, and the muriate of quicksilver, the subacetite and the 
" sulphate of copper; and perhaps the oxidum arsenici^ but 
" I have not used this last,) which may lay hold on and des- 
" troy those innumerable fungous excrescences, which grow 
" out of those diseased vessels ? This seems to arrest the 
"morbid action at once, and thus prevent their further raor. 
" bid secretion. After which some unctuous application 
" calculated to restore the action of the absorbents, and keep 
"the skin soft and pliant, will heal the ulcerated parts and 
" complete the cure. On this ground the tar ointment was 
" preferred in the foregoing cases, to other unctuous sub- 
" stances. But cyery application for answering the above pur- 
"'poses, should be always preceded by ablution to givethe med- 
"icament a fair chance to take effect, and also for the pur.. 
" pose of removing so hurtful an agent, as well as for other 
"good purposes. 

"And as I would not trust the cure to internal remedies 
"alone; so neither would I wholly omit their use. And as 
" the action of mercurials and antimonials combined, when 
" given in small doses, is directed strongly to the surface ; so 
" their use may, I think, contribute somewhat towards re- 
" storing the healthy action of the vessels of the skin, and 
" contribute something to the cure. And as the change in 
"the circulation, occasioned by the removal of an inflam- 



180 

v - mation as extensive as the surface of the body ; and as the 
u cessation of a discharge, though a morbid one, as copious as 
u this increased secretion from the surface, might materially 
c4 affect the system, I have thought it expedient, occasionally 
iC to interpose gentle cathartics. In regard to any other med- 
u icines, the circumstances of the patient, as they may occa- 
Ci sionally present themselves, must alone instruct us, whether 
?i to use or refuse them. " 



NOTE (II) 

In the Philadelphia Medical Museum, p. 422, &c. is the 
following history of the case and of its cure : 

(6 In the year 1770, about the month of June, I had a num. 
ci ber of African slaves for sale, among them was a lad about 
Ci eighteen years of age, who was a miserable object from the 
a disorder called the yaws ; he was vastly more afflicted with it 
" than any disorder I ever saw before or since ; from his head 
u to his feet he was thick-set with all sorts of knots or ulcers, 
u which that disorder produces, when it is in its worst stages. 

u Among the slaves there were a few, who had been living 
iC for some time at one of the British factories in Africa, and 
" understood a little of the English language. Observing that 
il I was at a loss what to do with this diseased slave, they un- 
ii dertook to cure him, to which I readily consented, but with 
i( - very little faith in their success. 

u The cure was as follows : 

u They took him to a running stream of water, laid him in 

u it, two confined his feet, two his arms,, and one held up his 

*' head to prevent drowning ; two then operated in scrubbing 

H off the knots and ulcers in the running water. The opera- 



181 



Ci tion must have been dreadful, for they scrubbed him with 
" corn-husks, and even sand ; the blood, and matter, and scabs 
<c were constantly washed down the stream : when every ulcer 
rt was thus smoothed away and cleansed by the running water, 
u they led him up naked to the house, and wiped him ; then 
u they made an ointment of the j uice of limes made boiling hot, 
(i and mixed to a proper consistence with powdered iron-scales 
a taken from a blacksmith's anvil : with this ointment they 
ci anointed every sore with a feather ; the same operation was 
u continued for four weeks ; every six or seven days, they gave 
Ci him frequently a decoction of some roots, which I believe 
u operated as a purgative : in about eight weeks they complet- 
" ed a cure ; in three or four months, he became sleek, fat, 
Ci and a very likely fellow ; all the sores skinned over, and no 
iC scar remained. I sold him afterwards, and never heard that 
" the complaint returned. 

"David Ross." 



The report of this case of yaws agrees very well with the 
history of the disease, as given by Dr. Winterbotham and Dr. 
Joseph Adams, who observe that the powers of the constitu- 
tion are ultimately adequate to its cure. 



NOTE (I) 

The only occasional causes that I am able to point out, 
with any certainty, as contributing to the production of lepra 
vulgaris, are exposure to cold and moisture, and the accumu- 
lation of sordes upon the skin. Hence persons engaged in 
some particular lines of business are more subject to this disease, 
and especially those who work among dry powdery substances 
(as brick-layers, labourers, coal heavers, laboratory men,&c.) 
as also many of the labouring poor, who arc much exposed to 
cold, and almost constantly surrounded with dust or dirt. 



182 



without procuring even a temporary enjoyment of clean- 
liness. 

Willan on Cutaneous Diseases, p. 126. 



NOTE (J) 

The following history of this loathsome complaint is trans- 
cribed from Pinkard's notes on the West-Indies. * 

a The elephantiasis, called by some the " glandular dis- 
Ci ease" but, by the many, designated simply the u Barba- 
Ci does disease, 91 commonly appears in the form of an enor- 
i6 mous and frightful enlargement of one or both legs ; but 
w occasionally affects other parts, particularly the scrotum, 
Ci which becomes increased to a surprising bulk. When once 
Ci established, it is extremely difficult to remove, and for the 
Cf most part proves to be incurable. It affects the general 
66 health less than might be expected, and frequently exists 
44 for many years without seeming materially to impair the 
u constitution ; often, indeed, the person attacked with it 
iC bears it about through the remainder of a long life. It is 
" mostly seen among the negroes, but it is too common also 
u among the Creole whites, and even suffers not the Euro- 
i( peans to escape. Although so frequent in Barbadoes as to 
u beheld in a great degree peculiar or endemial,itis not wholly 
" confined to this country : some instances of it being seen 
" in the neighbouring islands. 

6C It would seem not to have been so prevalent as it now is 
i ; for any very distant period of time; for about the year 
" 1760 died at Barbadoes a man named Francis Briggs, more 
iC commonly known by the fictitious appellation of Christo- 

* Vol. ii. p. 119—130. 



183 

c; pher Columbus, who, from the uncommon and monstrous 
"appearance of his legs, had been represented as the bug-bear 
44 or object of terror for the purpose of frightening children. 

" Male and female, young, middle-aged, and old, black 
•• and white, are now all subject to its attack ; and in walk. 
44 ing the streets, the eye is distressed at almost every corner 
" with the appearance of this hideous deformity. 

44 The disease usually begins with an affection of the in- 
44 guinal glands, from whence a red streak or line of inflamma- 
44 tion extends down the limb, in the direction of the lymphatic 
44 vessels; the part affected becoming tumefied, and taking 
44 on an oedematous and shining appearance. The swelling 
" gradually occupies the whole of the leg, increasing until, in 
44 many instances, the limb is more than double its ordinary 
"size. The skin assumes a morbid appearance, grows rough 
" and scaly, or is covered with irregular wart-like risings. 
44 In some cases deep belts or indentations appear in various 
" parts of the tumour, as if formed by the pressure of liga- 
" tures : in others the swelling bulges out in a number of ir- 
" regular protusions : sometimes, from extreme distention, 
"the skin ruptures or breaks into cracks and fissures, and a 
44 watery fluid oozes out, which on exposure to the air grows 
''gelatinous upon the surface. The foot frequently partakes 
" of the. disease, but in many cases the immense tumour of 
"the leg terminates abruptly at the ancle, hanging over the 
44 foot in knotty and scaly excrescences. The deformity thus 
64 becomes diversified ; the enormous bulk of leg appearing 
44 under a variety of unseemly and disgusting forms. As the 
44 enlargement increases, the whole extremity becomes hard 
24 and scaly ; and the distended skin, which at first indented, 
44 grows thick and corneous, and wholly resists the pressure 
44 of the linger. 



184 



"It has been found on dissection, that, from the effused 
"lymph which originally caused the tumour having become 
" coagulated and hardened, the substance of the enlarged 
"limb has assumed an appearance not unlike brawn ; the 
"morbid skin and cellular membrane under it having grown 
^ c into a tough, horny, and almost cartilaginous consistence, 

" From this unsightly malady being mostly accompanied 
" with fever of an intermittent type, we often hear it termed 
u - the " fever and ague." Indeed from the periodical returns 
" of the paroxysms, and from the tumefaction succeeding to 
" them, the disease has very generally been considered only as 
" an effect resulting from an intermittent fever. The practice, 
" said to be successful in removing it, seems also to be found- 
" ed upon this view of it. Regard being had to the fever as 
" the original affection, the elephantiasis is considered only as 
" a sequel, and the curative means are directed solely to the 
" removal of the febrile symptoms : which being effected by 
"antimony and the bark, the patient is sent to some other 
"island by way of change of climate, in order to prevent a 
" relapse. No particular* attention is paid to the tumour, 
" which on the fever being removed, is expected gradually to 
" subside. But sometimes, instead of receding, it remains 
" stationary, or is increased ; or if it subside, is renewed on 
" any future recurrence of the fever. 

" Often to return to Barbadoes brings a return of the inter- 
" mittent, and a consequent addition to the enlargement of the 
" already thickened extremity ; and, from the attacks of the 
" disease recurring in frequent repetition, there remains no 
"way of preventing it from being established into an un- 
" seemly deformity, but by seeking the remedy of a more 
" temperate eiimate. Frequently the disorder seems to be 
" subdued entirely by a few years' residence in England, jet 
"again recurs on the patient returning to Barbadoes. 



185 

'* Some regard the disease in a directly opposite point of 
i( view, considering the glandular tumour, with its attendant 
u inflammation of the lymphatics as the primary affection, 
66 and the fever merely as symptomatic. It is not consistent 
u with my present purpose, nor does experience warrant me to 
a enter more minutely into this question ; but I may offer you 
(i a few extracts of cases wherefrom you will be enabled to 
u collect a more just and accurate idea of the commencement 
(C and the progress of this singular and distressing malady. 

" Mr. Daniel Massiah, aged fifty-three, of the Jewish re- 

cc ligion, was a very healthy boy till eighteen, when he was 

u attacked with a disease, which at that period was very 

" unusual indeed. Without any known cause he complained 

u of a soreness and swelling of the left groin. When he had 

ct felt this about a quarter of an hour, he was seized with the 

Ci cold fit of fever; a burning hot fever succeeded, which was 

c( followed by profuse sweating. The whole paroxysm was 

" accompanied with violent pains of the head and back, and 

" great sickness at the stomach, and reaching. This first at- 

" tack left very little swelling in the left ancle. From this 

iC fit, for the four following years, he had this disease in the 

c6 same manner about once a month, with a gradual increase 

u of the left leg ; so that it became eighteen or twenty inches 

" round the calf. After he was twenty -two years of age, the 

u attacks were five, six, seven or eight times each year. 

" From the year 1764, being then about thirty-six, he has 

cc been irregularly attacked, sometimes in the right, and some- 

" times in the left leg ; each time the legs were left larger and 

ci larger. At the age of thirty-nine the right leg was consid- 

" erably increased in size. In the centre of the calf of this 

u leg there arose a lump as big as a goose's Qgg^ which burst of 

" itself, and discharged a fluid as clear as water in large quan- 

tl tity. The swelling abated, but each succeeding attack left 

6i the leg so increased in bulk, that at this time it measures 

Z 



186 



Ci thirty-six inches in every part of the leg, from below the 
6i knee to the ancle. The feet of both legs are of their natural 
a size. The left leg measures twenty-six inches. The swell - 
" ing is very smooth, except on the right heel, where there are 
u great excrescences, which have the appearance of large 
a corns or warts. The increase of the legs seems to have 
6i been so gradual, that he has not been in the least sensible of 
iC it ; nor has he experienced any other inconvenience from 
u the disease, except when he has been weakened by sickness, 
" and then he feels his legs heavy. 

a During the first sixteen years of his being subject to the 
iC disease, the local affections were always evident. Since that 
(,i time, i. e. for about twenty years past, but more particu- 
6i larly lately, he has scarcely been able to determine whether 
iC the local symptoms or the cold fit came on first. He says, 
a that lately he finds the first' local symptom to be a purple 
a hue on the finger nails, and a great coldness in the palms of 
iC the hands. His appetite is very good, every function of 
a life is uninterrupted, and he has been free from every other 
ci disease." 

u Mr. F— , aged twenty-six, a native of Barbadoes, since 
u the age of eleven, has been subject to the glandular disease. 
u It first attacked him with a swelling of the leg and thigh ? 
u which he perceived in the morning on rising from bed. The 
u swelling of the extremity was uniform, and except a little 
u pain which he felt in the groin, where on examination the 
" glands were found enlarged, was not attended with the least 
4i mark of inflammation or fever. This enlargement continu- 
u ed for about fourteen days, when he was seized with a regu- 
u lar paroxism of fever; which however was preceded by a 
" red streak in t\iQ thigh, and a considerable affection of the 
u inguinal glands. A violent inflammation of the leg and 
" thigh immediately preceded the hot fit, and continued for 



187 

" seven or eight days. The disease left a great degree of 
iC swelling, which has continued with little variation ever 
'* since. About two years after, the attacks being frequent, 
a he was advised to change his climate, and accordingly went 
" to England, where his general health was much improved. 
Ci During his stay there, which was about eight months, he 
;c ,had no fresh attack from the glandular disease ; but the en- 
(i largement continued nearly the same. Soon after his return 
iC to Barbadoes, he had a regular attack of the glandular dis- 
" ease, which lasted as long, and was as severe as those he had 
st experienced before he went to England. These returns 
u continued for several years to be very frequent, but lately 
i( have been much diminished, both in number and severity." 

Ci The history of the patient's case, whose leg I dissected, 
'• as far as I could inform myself, was as follows : she had 
"laboured under the glandular disease for ten years : the 
" first attack was at fifteen years of age, and was attended with 
" fever. At every return she found her leg much inflamed, 
66 increased in size, stiff, contracted, and gradually enlarged, 
"till it became so enormous as to be extremely troublesome. 
"She then applied to me to perform amputation, of which 
u she recovered ; but was soon after seized with the same dis- 
u ease in the other leg, and died in consequence of it."* 

" Different opinions have been held respecting the origin 
" of this singular affection. From it being most frequent, or 
u first observed among the negroes, many have believed it to 
" be imported with them from the shores of Africa. But this 
" opinion is divested of probability, by the extraordinary 
" prevalence of the disease at Barbadoes. Were it brought 
" by the slaves from Africa, it would be equally common in 
" the other islands ; and not being infectious, would not be 

* Hertdv on the Glandular Disease of Barbadoes. 



188 

"'seen, among the white Creoles, or the Europeans. It is un- 
" doubtedly the indigenous offspring of the island, and possi- 
u bly is connected with a peculiarly arid state of the atmos- 
ic phere ; for in the islands shadowed with thick forests and 
(C vegetation, it is still unknown, and has only grown common 
ci at Barbadoes, in proportion as its woods have been remov- 
u ed, and the surface of the island left unsheltered. 

Ci Except on its early attack, or at the periods of acute re- 
u lapse, the disease is attended with little or no pain, and the en- 
largement sometimes proceeds so gradually, as for the person 
<fi himself to be in a degree insensible of it. He walks about as 
u usual, and appears to suffer but little inconvenience, either 
iC from the additional bulk, or the great increase of weight. 
a Hence it is often less afflicting to the individual, than offen* 
iC sive to others. It is extremely repugnant to the sight, and 
" as the negroes go about the streets with these diseased limbs 
Ci exposed to every eye, Europeans but recently arrived, are 
ct extremely annoyed by their filthy and monstrous appearance. 

ci Perhaps nature has not formed, nor can the human 
iC mind conceive an object at once so disgusting, and so pitia- 
a ble, as an old half famished negro woman — of withered 
" frame — tottering and trembling about with her loose and 
" naked skin hanging shriveled in deep furrowed wrinkles ; 
u and dragging after her one or both legs grown into an im- 
iC mense bulk of hideous disease — her feet only toes, protrude 
u ing from this huge mass of distempered leg." 



NOTE (K) 
A physician of great professional industry and of long ex- 
perience informed me, that he once had a patient, a robust 
map. of middle age, who, from a blow upon the inter!- 



189 

or of his thigh, was affected with a soreness and tumour upon 
the part stricken, which gradually increased, until he was in- 
capable of business. After trying discutients to no purpose, 
it was at leng.th agreed upon in consultation, that an incision 
should be made into the tumour under an apprehension, that it 
contained coagulated blood, which it would be necessary to 
remove. After the tumour was laid open, effused lymph was 
found. The wound was cleansed with a sponge and warm 
water. No bleeding vessel was discovered. Afterwards up- 
on dressing the wound, instead of finding forming granula- 
tions, the part had assumed a glassy appearance. The part 
was spunged out the second time with a view to detect the 
weeping orifice of the wounded lymphatic ; but it was so mi- 
nute as to elude discovery. The sore exhibited the same ap- 
pearances from day to day without discovering any disposition 
to heal. The patient, being wearied out by its tardiness to 
heal under the treatment of skilful physicians, put himself un- 
der the care of a quack, and died soon afterwards. The case 
is here imperfectly reported from the fancied resemblance its 
cause bears to the probable cause of elephantiasis. 



NOTE (L) 

Lorry de Morbis Cutaneis, p. 132. Solis diluentibus 
sanatur malum, & si recrudescat, levi catharsi tollitur. Ve- 
rum talis veneni suramam efficaciam legere qui voluerit, legat 
ILL. de Sauvage dissertationem de imprudenti esu hepatitis 
illius piscis, qui Linnaso squalus catulus dicitur, Gallus vocatur 
chat marin, quod praeter profundum sommum ruboremque 
omnium partium quem intulerat, tertio die epidermidem a cute 
subjecta ita secedere coegit, ut vigessimo etiam die lamellas 
hujus quasi papyrum aeger detraheret & illustrissimo de Sau- 
vage dono daret 



190 

NOTE (M) 

Haller in his Elementa Physiologia?, vol. vi, p. 578, re- 
marks, it is said) that biliary calculi abound in certain places 
from the use of an acid wine, and among hard drinkers, but 
they are frequent in those places where beer is the principal 
drink and afflict females, who use water as their common drink. 

The following are his words : Ob vinum acidum certis 
locis abundare legi ; et in bibacibus frequentes esse. Sed 
ostendiin regione cerevisia pena sola utente maxime frequen- 
ces esse, turn nostras in feminis, quae tamen vulgo solam aquam 
bibunt. P. 564, the same author, in speaking of those most 
subject to biliary concretion, Juniorisei minus obnoxiae sunt y 
senes magis, turn feminas. 

Hoffman, in his Opuscula Pathologico-Practica, p. 196, 
while treating upon the same subject, has the following pas- 
sage. Saepissime in hypochondiacis, in hystericisycolica atro- 
ci laborantibus, item ab iracundia graviori Jlavum colorem 
per totum corpus dispergi, fyc. 

Dr. Heberden has the following upon the same subject. 

u Men and women are equally liable to this malady : in a 
"continued succession of a hundred patients, I counted 52 
u males and 48 females." 



NOTE (N) 

Fourcroy in his Chemistry, vol. x, p. 44, gives the follow- 
ing chemical history of the bile. 

" All the known facts relative to the chemical properties 
" and the analysis of the bile, which I have collected in this 



191 

u article, show that this liquid is of a very compound nature, 
" and that it especially differs from most other animal sub- 
" stances that have hitherto been examined. It contains, as has 
iC cither been proved by the facts enunciated, or indicated ac- 
u cording to experiments more or less advanced. 

u A. A large quantity of water. 

"B. Soda. 

" C. An oily matter united with the latter in the sapona- 
iC ceous state. 

u D. A colouring matter combined with the preceding 
K kind of soap. 

u E. A bitter and odorous oily substance. 

"F. A coagulable animal substance. 

li G. A kind of saccharine substance analogous to the su- 
•' gar of milk. 

66 H. Salts of several kinds. 

u I. Lastly, oxide of iron." 



NOTE (O) 

Dr. Herberden concludes his observations upon jaundice 
in his Commentaries upon the History of Diseases, in the fol- 
lowing words. 

66 Before I conclude, it may be of some use to observe, 
ci that biliary concretions are probably one cause, amidst va- 
" rious others, of that commonest of all complaints, an uneasU 
u ness or pain of the stomach. This I have been induced to 
ii believe from finding that in many persons a pain of the 
u stomach, which had frequently afflicted them for months, 
Ci or years, has at last been joined by a jaundice. When a 
" pain therefore of this kind frequently returns without any 
*''• other manifest cause, especially if there be at the same time 



192 

" a sensation of fulness, a thickening of the bile may general - 
" ]y be suspected, &c." 

Haller's Physiologia, vol. v, p. 575 — 6, contains the 
following : 

u Etiam in raphani rusticani succo, crust a exterior mol- 
u lescit, fy in succo cochlearise, atque nasturcinarum planta- 
Ci rum hi calculi solvuntur, ut arena sit in alvi excrementis, 

u Etiam in universum succus vegetabilium recentium icte- 
u rum sanat, Sf fecit, ut calculi fragment a prodirent ; <5f in 
6i Hungaricis bo bus, adeo crustis biliariis infest atis, uti dici- 
Ci mus, recens fy vernale gramen ita solvit, ut Vienna? nullus 
Ci calculus super sit, quo aguntur." 

Many physicians of modern times seem to have embraced 
these opinions of Haller respecting the solubility of biliary 
concretions in the juices of recent vegetables, for in this vicin~ 
ity they have been a common prescription for those affected 
with chronic jaundice. 

THE END, 



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